ArticleAnnals of surgical oncology2026
High Prevalence of Clinical Understaging in Early Gastric Cancer: An Analysis of the NCDB.
Article in Annals of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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Who cites it
1 citing paper in PubMed.
- ASO Author Reflections: Clinical Staging of Early Gastric Cancer-We're Still Missing the Mark.Annals of surgical oncology · 2026Article
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThis study aimed to identify the incidence of clinical understaging in early gastric cancer (GC) and to identify variables associated with increased risk of a patient being understaged.
methodsClinical stage I (T1/2 N0) GC patients undergoing oncologic resection without neoadjuvant therapy from 2013 to 2020 were identified in the National Cancer Database (NCDB). Patients found to have a higher stage of cancer on final pathologic review were considered understaged. Clinicopathologic predictors of understaging were identified using multivariable logistic regression. The relationship between identified variables and understaging was modeled using logistic regression with natural cubic splines to allow for a flexible, nonlinear analysis. Cox proportional hazards analysis and Kaplan-Meier curves were used to evaluate survival outcomes.
resultsThe study identified 4370 clinical stage I GC patients, 36% of whom were initially understaged on clinical staging. Tumor size per millimeter increase (OR, 1.05; 95% confidence interval CI 1.04-1.05; p < 0.001), higher grade (moderate: OR, 2.76; 95% CI 1.99-3.84; poor/anaplastic status: OR, 5.99; 95% CI 1.99-3.84, p < 0.001), and non-academic treatment facilities (OR, 1.19; 95% CI 1.03-1.38; p = 0.017) were associated with increased risk of understaging. Spline analysis showed increased risk of understaging based on tumor size. This was compounded when tumor differentiation was considered, such that a tumor measuring 2.5 cm was associated with 16.9%, 31.8%, or 51.6% likelihood of clinical understaging if the tumor was well, moderately, or poorly differentiated, respectively. Understaging was associated with increased mortality (OR, 2.31; 95% CI 2.10-2.95; p < 0.001).
conclusionsMore than one third of clinical stage I GC patients are understaged. Tumor grade and size should be considered at preoperative evaluation of early GC to improve identification of patients at risk for understaging.
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