Reappraise role of lymph node status in patterns of recurrence following curative resection of gastric adenocarcinoma

Abstract

Objective To examine the association between lymph node status and recurrence patterns in completely resected gastric adenocarcinoma. Methods We retrospectively assessed 1,694 patients who underwent curative gastrectomy from January 2010 to August 2014. Patients stratified according to lymph node status and recurrence patterns among different subgroups were compared. Results Of all, 517 (30.5%) patients developed recurrent disease, and complete data of recurrence could be obtained in 493 (95.4%) patients. For pN0 patients, the patterns of recurrence were different according to pT stage: locoregional recurrence was most common in patients with pT1−2 disease (57.1%), distant recurrence was most common in patients with pT3 disease (57.1%), and peritoneal recurrence was most common in patients with pT4a disease (66.7%). For pN+ patients, distant metastasis was most common pattern irrespective of pT stage. The site-specific trend of recurrence showed that locoregional recurrence increased within 5 years in patients with pN0−2 disease but plateaued 3 years after surgery in patients with pN3 disease. Time to recurrence was significantly longer for the pN0 patients compared with the pN+ patients (median: 25 vs. 16 months, P=0.001). Moreover, post-recurrence survival was significantly better for the pN0 patients than for the pN+ patients (median: 12 vs. 6 months, P<0.001), especially in patients with non-peritoneal recurrence, late recurrence, single recurrence, and receipt of potential curative treatment. Conclusions Among clinicopathologic factors, lymph node status is the most important factor associated with recurrence patterns after curative gastrectomy. Lymph node status may be used as an adjunct in clinical decision-making about postoperative therapeutic and follow-up strategies.

Pattern of recurrence and overall survival in esophagogastric cancer after perioperative FLOT and Clinical Outcomes in MSI-H population: The PROSECCO Study.

“…The median PFS for MSS/pMMR pts was 20.49 months (95% CI 17.83-25.2), whereas the median PFS was not reached in the MSI-H/dMMR group (p = 0.0325). Furthermore, there was a statistically significant difference in the rate of negative lymph node status between the MSS/pMMR and MSI-H/dMMR cohort (30.7% vs. 63%, p = 0.0018), and indeed nodal positivity is a wellknown negative prognostic factor for relapse and OS in multiple studies (Smyth et al 2016;Tang et al 2021;Tran-Minh et al 2021).…”

Pattern of recurrence and overall survival in esophagogastric cancer after perioperative FLOT and clinical outcomes in MSI-H population: the PROSECCO Study

“…The median PFS for MSS/pMMR pts was 20.49 months (95% CI 17.83–25.2), whereas the median PFS was not reached in the MSI-H/dMMR group ( p = 0.0325). Furthermore, there was a statistically significant difference in the rate of negative lymph node status between the MSS/pMMR and MSI-H/dMMR cohort (30.7% vs. 63%, p = 0.0018), and indeed nodal positivity is a well-known negative prognostic factor for relapse and OS in multiple studies (Smyth et al 2016 ; Tang et al 2021 ; Tran-Minh et al 2021 ).…”

Radiomics signature for prediction of long-term survival and recurrence patterns in patients with gastric cancer after radical gastrectomy: A multicenter study

“…Data on the recurrence patterns provide valuable information for conducting appropriate therapies and effective follow-up examinations. [ 32 33 ] Clinicopathologic factors associated with recurrence patterns have been extensively investigated. In 386 patients with GC who developed recurrence after resection, patterns of recurrence varied significantly based on the Lauren histologic type.…”