Sada YH, et al. - Researchers performed this retrospective cohort study of gastric cancer patients (aged 18 to 80 y) in the National Cancer Database (2006-2014) with ≥T2 and/or node-positive disease (i.e., stage Ib to III) treated with multimodality therapy (MMT) to assess current national practice patterns and sequencing of MMT. Perioperative MMT was provided to 16.1% of 5817 patients, 50.6% received MMT preoperative only, and 33.3% postoperative only. The clinical nodal staging showed sensitivity, specificity, positive predictive value, and negative predictive values of 68.4%, 88.8%, 91.1%, and 62.7%, respectively. Understaging of 37.3% of clinically node-negative patients was noted using current clinical nodal staging modalities. Over time, decreased utilisation of radiation (74.3% in 2006 vs 53.9% in 2014), increased use of perioperative MMT (8.9% vs 22.2%%), and decreased use of postoperative MMT (43.1% vs 21.0%) were reported. Risk of death was not evident in correlation to either type of MMT or treatment sequence. The findings emphasize making efforts directed at improving and optimizing preoperative therapy utilization in view of the high false negative rate of clinical nodal staging and high noncompletion rate of postoperative treatment.