Impact of upfront randomization for postoperative treatment on quality of surgery in the CRITICS gastric cancer trial

Y. H. M. Claassen, H. H. Hartgrink, W. O. de Steur, J. L. Dikken, J. W. van Sandick, N. C. T. van Grieken, A. Cats, A. K. Trip, E. P. M. Jansen, W. M. Meershoek-Klein Kranenbarg, J. P. B. M. Braak, H. Putter, M. I. van Berge Henegouwen, M. Verheij, C. J. H. van de Velde

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Preoperative randomization for postoperative treatment might affect quality of surgery. In the CRITICS trial (ChemoRadiotherapy after Induction chemotherapy In Cancer of the Stomach), patients were randomized before treatment to receive chemotherapy prior to a D1 + gastrectomy (removal of lymph node station (LNS) 1–9 + 11), followed by either chemotherapy (CT) or chemoradiotherapy (CRT). In this analysis, the influence of upfront randomization on the quality of surgery was evaluated. Methods: Quality of surgery was analyzed in both study arms using surgicopathological compliance (removal of ≥ 15 lymph nodes), surgical compliance (removal of the indicated LNS), and surgical contamination (removal of LNS that should be left in situ). Furthermore, the ‘Maruyama Index of Unresected disease’ (MI) was evaluated in both study arms, and validated with overall survival. Results: Between 2007 and 2015, 788 patients with gastric cancer were included in the CRITICS study of which 636 patients were operated with curative intent. No difference was observed between the CT and CRT group regarding surgicopathological compliance (74.8% vs 70.9%, P = 0.324), surgical compliance (43.2% vs 39.2%, P = 0.381), and surgical contamination (59.4% vs 59.9%, P = 0.567). Median MI was 1 in both groups (range CT 0–88 and CRT 0–136, P = 0.700). A MI below 5 was associated with better overall survival (CT: P = 0.009 and CRT: P = 0.013). Conclusion: Surgical quality parameters were similar in both study arms in the CRITICS gastric cancer trial, indicating that upfront randomization for postoperative treatment had no impact on the quality of surgery. A Maruyama Index below five was associated with better overall survival.
Original languageEnglish
JournalGastric Cancer
DOIs
Publication statusE-pub ahead of print - 2018

Cite this

Claassen, Y. H. M. ; Hartgrink, H. H. ; de Steur, W. O. ; Dikken, J. L. ; van Sandick, J. W. ; van Grieken, N. C. T. ; Cats, A. ; Trip, A. K. ; Jansen, E. P. M. ; Kranenbarg, W. M. Meershoek-Klein ; Braak, J. P. B. M. ; Putter, H. ; van Berge Henegouwen, M. I. ; Verheij, M. ; van de Velde, C. J. H. / Impact of upfront randomization for postoperative treatment on quality of surgery in the CRITICS gastric cancer trial. In: Gastric Cancer. 2018.
@article{bed79c5839bf47589a5b13699a0bac6b,
title = "Impact of upfront randomization for postoperative treatment on quality of surgery in the CRITICS gastric cancer trial",
abstract = "Background: Preoperative randomization for postoperative treatment might affect quality of surgery. In the CRITICS trial (ChemoRadiotherapy after Induction chemotherapy In Cancer of the Stomach), patients were randomized before treatment to receive chemotherapy prior to a D1 + gastrectomy (removal of lymph node station (LNS) 1–9 + 11), followed by either chemotherapy (CT) or chemoradiotherapy (CRT). In this analysis, the influence of upfront randomization on the quality of surgery was evaluated. Methods: Quality of surgery was analyzed in both study arms using surgicopathological compliance (removal of ≥ 15 lymph nodes), surgical compliance (removal of the indicated LNS), and surgical contamination (removal of LNS that should be left in situ). Furthermore, the ‘Maruyama Index of Unresected disease’ (MI) was evaluated in both study arms, and validated with overall survival. Results: Between 2007 and 2015, 788 patients with gastric cancer were included in the CRITICS study of which 636 patients were operated with curative intent. No difference was observed between the CT and CRT group regarding surgicopathological compliance (74.8{\%} vs 70.9{\%}, P = 0.324), surgical compliance (43.2{\%} vs 39.2{\%}, P = 0.381), and surgical contamination (59.4{\%} vs 59.9{\%}, P = 0.567). Median MI was 1 in both groups (range CT 0–88 and CRT 0–136, P = 0.700). A MI below 5 was associated with better overall survival (CT: P = 0.009 and CRT: P = 0.013). Conclusion: Surgical quality parameters were similar in both study arms in the CRITICS gastric cancer trial, indicating that upfront randomization for postoperative treatment had no impact on the quality of surgery. A Maruyama Index below five was associated with better overall survival.",
author = "Claassen, {Y. H. M.} and Hartgrink, {H. H.} and {de Steur}, {W. O.} and Dikken, {J. L.} and {van Sandick}, {J. W.} and {van Grieken}, {N. C. T.} and A. Cats and Trip, {A. K.} and Jansen, {E. P. M.} and Kranenbarg, {W. M. Meershoek-Klein} and Braak, {J. P. B. M.} and H. Putter and {van Berge Henegouwen}, {M. I.} and M. Verheij and {van de Velde}, {C. J. H.}",
year = "2018",
doi = "10.1007/s10120-018-0875-1",
language = "English",
journal = "Gastric Cancer",
issn = "1436-3291",
publisher = "Springer Japan",

}

Claassen, YHM, Hartgrink, HH, de Steur, WO, Dikken, JL, van Sandick, JW, van Grieken, NCT, Cats, A, Trip, AK, Jansen, EPM, Kranenbarg, WMM-K, Braak, JPBM, Putter, H, van Berge Henegouwen, MI, Verheij, M & van de Velde, CJH 2018, 'Impact of upfront randomization for postoperative treatment on quality of surgery in the CRITICS gastric cancer trial' Gastric Cancer. https://doi.org/10.1007/s10120-018-0875-1

Impact of upfront randomization for postoperative treatment on quality of surgery in the CRITICS gastric cancer trial. / Claassen, Y. H. M.; Hartgrink, H. H.; de Steur, W. O.; Dikken, J. L.; van Sandick, J. W.; van Grieken, N. C. T.; Cats, A.; Trip, A. K.; Jansen, E. P. M.; Kranenbarg, W. M. Meershoek-Klein; Braak, J. P. B. M.; Putter, H.; van Berge Henegouwen, M. I.; Verheij, M.; van de Velde, C. J. H.

In: Gastric Cancer, 2018.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Impact of upfront randomization for postoperative treatment on quality of surgery in the CRITICS gastric cancer trial

AU - Claassen, Y. H. M.

AU - Hartgrink, H. H.

AU - de Steur, W. O.

AU - Dikken, J. L.

AU - van Sandick, J. W.

AU - van Grieken, N. C. T.

AU - Cats, A.

AU - Trip, A. K.

AU - Jansen, E. P. M.

AU - Kranenbarg, W. M. Meershoek-Klein

AU - Braak, J. P. B. M.

AU - Putter, H.

AU - van Berge Henegouwen, M. I.

AU - Verheij, M.

AU - van de Velde, C. J. H.

PY - 2018

Y1 - 2018

N2 - Background: Preoperative randomization for postoperative treatment might affect quality of surgery. In the CRITICS trial (ChemoRadiotherapy after Induction chemotherapy In Cancer of the Stomach), patients were randomized before treatment to receive chemotherapy prior to a D1 + gastrectomy (removal of lymph node station (LNS) 1–9 + 11), followed by either chemotherapy (CT) or chemoradiotherapy (CRT). In this analysis, the influence of upfront randomization on the quality of surgery was evaluated. Methods: Quality of surgery was analyzed in both study arms using surgicopathological compliance (removal of ≥ 15 lymph nodes), surgical compliance (removal of the indicated LNS), and surgical contamination (removal of LNS that should be left in situ). Furthermore, the ‘Maruyama Index of Unresected disease’ (MI) was evaluated in both study arms, and validated with overall survival. Results: Between 2007 and 2015, 788 patients with gastric cancer were included in the CRITICS study of which 636 patients were operated with curative intent. No difference was observed between the CT and CRT group regarding surgicopathological compliance (74.8% vs 70.9%, P = 0.324), surgical compliance (43.2% vs 39.2%, P = 0.381), and surgical contamination (59.4% vs 59.9%, P = 0.567). Median MI was 1 in both groups (range CT 0–88 and CRT 0–136, P = 0.700). A MI below 5 was associated with better overall survival (CT: P = 0.009 and CRT: P = 0.013). Conclusion: Surgical quality parameters were similar in both study arms in the CRITICS gastric cancer trial, indicating that upfront randomization for postoperative treatment had no impact on the quality of surgery. A Maruyama Index below five was associated with better overall survival.

AB - Background: Preoperative randomization for postoperative treatment might affect quality of surgery. In the CRITICS trial (ChemoRadiotherapy after Induction chemotherapy In Cancer of the Stomach), patients were randomized before treatment to receive chemotherapy prior to a D1 + gastrectomy (removal of lymph node station (LNS) 1–9 + 11), followed by either chemotherapy (CT) or chemoradiotherapy (CRT). In this analysis, the influence of upfront randomization on the quality of surgery was evaluated. Methods: Quality of surgery was analyzed in both study arms using surgicopathological compliance (removal of ≥ 15 lymph nodes), surgical compliance (removal of the indicated LNS), and surgical contamination (removal of LNS that should be left in situ). Furthermore, the ‘Maruyama Index of Unresected disease’ (MI) was evaluated in both study arms, and validated with overall survival. Results: Between 2007 and 2015, 788 patients with gastric cancer were included in the CRITICS study of which 636 patients were operated with curative intent. No difference was observed between the CT and CRT group regarding surgicopathological compliance (74.8% vs 70.9%, P = 0.324), surgical compliance (43.2% vs 39.2%, P = 0.381), and surgical contamination (59.4% vs 59.9%, P = 0.567). Median MI was 1 in both groups (range CT 0–88 and CRT 0–136, P = 0.700). A MI below 5 was associated with better overall survival (CT: P = 0.009 and CRT: P = 0.013). Conclusion: Surgical quality parameters were similar in both study arms in the CRITICS gastric cancer trial, indicating that upfront randomization for postoperative treatment had no impact on the quality of surgery. A Maruyama Index below five was associated with better overall survival.

UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85053700646&origin=inward

UR - https://www.ncbi.nlm.nih.gov/pubmed/30238171

U2 - 10.1007/s10120-018-0875-1

DO - 10.1007/s10120-018-0875-1

M3 - Article

JO - Gastric Cancer

JF - Gastric Cancer

SN - 1436-3291

ER -