Nearly half of T2N0 gastric cancer patients experience upstaging

Among 4,076 patients with clinical T2N0 gastric adenocarcinoma undergoing upfront resection, 47.4% were pathologically upstaged. Factors increasing upstaging included tumor size over 3.0 cm and poor differentiation. In patients upstaged, adjuvant chemotherapy correlated with significantly improved survival, whereas it had no survival benefit in non-upstaged patients. These findings suggest that surgical intervention may be prioritized for select patients to potentially avoid unnecessary chemotherapy, highlighting the need for accurate clinical staging.