Prediction of recurrence after curative resection of gastric carcinoma invading the muscularis propria: a multivariate analysis

Abstract

and early gastric cancer (EGC) as that confined to the mucosa or submucosa, regardless of the presence or absence of lymph node metastases. In Japan, the incidence of gastric cancer invading the muscularis propria (pm gastric cancer) accounts for about 10% of all patients with gastric cancer undergoing surgical resection [1,2]. The pm gastric cancer is usually treated by curative resection [3], and the 5-year survival rate for patients with pm gastric cancer was reported to be between 70% and 80%, a value between that for EGC and AGC [4,5]. Although pm gastric cancer belongs to the category of AGC, it is considered to be an intermediate stage between EGC and AGC [6], and the biological characteristics of pm gastric cancer are different from those of AGC [7].Recurrences of gastric cancer are likely to take a variety of forms and to be manifested in different organs, and the rate of recurrence increases in proportion to the degree of depth of invasion, even after curative resection for gastric cancer [8][9][10]. Although many prognostic factors for EGC and AGC have been identified [9,11], there are few reports concerning prognostic factors for pm gastric cancer, and the characteristics of recurrence are not well understood. For early detection and more effective treatment of recurrent disease, it is important to fully understand the relevant characteristics. We examined the clinicopathological characteristics of patients with pm gastric cancer in relation to recurrence. Patients and methods PatientsFrom 1965 to 1998, curative resection for 2437 Japanese patients with primary gastric cancer was done at the Second Department of Surgery at Kyushu University Hospital (Fukuoka, Japan). The present study is based Abstract Background. In Japan, the incidence of gastric cancer invading the muscularis propria is about 10% of all patients with gastric cancer undergoing surgical resection. Although many prognostic factors for early gastric cancer and advanced gastric cancer have been identified, there are few reports concerning prognostic factors for gastric cancer invading the muscularis propria, and the characteristics of recurrence are not well understood. Methods. We retrospectively analyzed data on 167 patients with gastric cancer that had invaded the muscularis propria. All patients had undergone curative resection. Results. Recurrences were evident in 37 patients (22.2%). Based on our univariate analysis, the recurrence was associated with lymph node metastases. Multivariate analysis showed that independent risk factors for recurrence were lymph node metastases and location of tumor in the upper or lower one-third of the stomach. With respect to the pattern of recurrence, 17 (46.0%) were secondary to hematogenous recurrence, 8 (21.6%) to peritoneal dissemination, and 6 (16.2%) to a local recurrence in the remnant stomach and in regional lymph nodes. Most deaths occurred during the second year after surgery, and approximately two-thirds of all patients (64.8%) died within 3 years after surgery. Conclusion. In patients ...

Clinicopathological analysis for recurrence of stage Ib gastric cancer (according to the second English edition of the Japanese classification of gastric carcinoma)

“…In patients with risk factors for recurrence, postoperative treatment may be a reasonable option to improve the prognosis of gastric cancer. In gastric cancer, the two most common recurrence patterns are hematogenous recurrence, in relatively earlystage cancer [7,8,11,12] and peritoneal dissemination in advanced gastric cancer [4,13]. In the present study, peritoneal dissemination was observed in seven of the patients with recurrence (64%), with one each having hematogenous and mixed-type recurrence.…”

Risk factors for recurrence in T1‐2N0 gastric cancer in the United States and China

“…However, our two cohorts had similar proportions of intestinal (66% US, 69% China) and diffuse (26% US and 29% China) tumors and similar distributions of well, moderate, and poorly differentiated histology, making them a good cohort for combined analysis. Recurrence rates in the US cohort were 2% (3/151) for T1a tumors, 7% (14/196) for T1b tumors, and 12% (8/67) for T2 tumors; quite similar to the rates in our Chinese cohort [T1a: 2% (4/209); T1b: 6% (12/187); T2: 14% (35/248)] and previous Eastern reports , which report recurrence rates ranging from 0.1% to 11.7% for T1a‐1bN0 patients, and 2.5% to 20.6% in T2N0 patients.…”

Heterogeneous prognoses of patients with tumors invaded within muscularis propria according to tumor depth in the layers of the muscularis propria

“…MP gastric cancer is usually treated by a curative surgical resection, and the 5-year survival rate was reported as 72% to 82% [3,4]. Although most patients with MP gastric cancer are cured by an R0 resection, 16% to 22% of these patients have recurrences postoperatively [3,5].There are many reports that the subclassifi cation of gastric cancer with invasion within the submucosal layer (SM gastric cancer) is useful to predict lymph node metastasis [6,7]. It remains unclear, however, whether subdivision of tumor invasion into the MP is useful for predicting lymph node metastasis and prognosis [8,9].…”

“…MP gastric cancer is usually treated by a curative surgical resection, and the 5-year survival rate was reported as 72% to 82% [3,4]. Although most patients with MP gastric cancer are cured by an R0 resection, 16% to 22% of these patients have recurrences postoperatively [3,5].…”