Hospital clinical staging accuracy for upper gastrointestinal malignancy

Area of Science:

• Oncology
• Surgical Oncology
• Health Services Research

Background:

• Clinical staging is crucial for multimodality treatment planning in upper gastrointestinal malignancies.
• However, the accuracy of clinical staging at the hospital level remains largely unexamined.

Purpose of the Study:

• To evaluate hospital-level accuracy in clinical staging for esophageal, gastric, and pancreatic adenocarcinomas.
• To assess the correlation of staging accuracy across these disease sites within individual hospitals.

Main Methods:

• A national cohort study utilized data from the National Cancer Database (NCDB) from 2006-2015.
• Included patients with adenocarcinoma of the esophagus, stomach, or pancreas treated with upfront resection.
• Calculated hospital-level staging accuracy by comparing clinical stage to pathologic stage and assessed cross-site correlations.

Main Results:

• 1246 hospitals were analyzed, showing median T-staging accuracy of 77.5% (esophageal), 73.7% (gastric), and 60.8% (pancreatic).
• Median N-staging accuracy was 80.2% (esophageal), 72.9% (gastric), and 61.8% (pancreatic).
• Under-staging was most common in pancreatic cancer (36.1% T-stage, 37.4% N-stage). Correlation across sites was weak (r=0.34 for T-stage, r=0.30 for N-stage).

Conclusions:

• Hospitals inaccurately stage 20-40% of patients with upper gastrointestinal cancers.
• Clinical staging accuracy varies significantly across hospitals and disease sites.
• The low correlation across disease sites highlights a need for improved staging consistency in multimodality treatment planning.