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

Abstract

Introduction Recurrence patterns after curative intent gastrectomy for T1-2N0 gastric adenocarcinoma are poorly defined. We sought to assess timing, patterns, and risk factors for recurrence in patients treated at two high-volume gastric cancer centers in the United States and China. Methods Between 1995 and 2011, 1,058 patients underwent curative intent gastrectomy. Recurrences were classified as locoregional, distant, or peritoneal. Univariate and multivariate analyses were performed to identify risk factors for recurrence. Results Overall, 7% (76) of our 1,058 patients from the United States (n=414) and China (n=644) recurred. Liver (43%) was the most common site of recurrence in both countries (US: 24%, China: 52%), followed by peritoneum (16%), lymph nodes (10%), and anastomosis (8%). Median time to recurrence was 23 months (US: 30 months, China: 23 months), which decreased with increasing T-stage (T1a: 27 months, T1b: 24 months, T2: 22 months). Tumor size (P=0.001), depth of invasion (P=0.010), histological type (P=0.022) and lymphovascular invasion (P=0.001) were independently associated with recurrence. Conclusion Patients infrequently recur following curative intent gastrectomy for T1-2N0 gastric adenocarcinoma. Almost all recurrences occur between six months and three years post-operatively, most frequently in distant anatomic locations, selective followup during this time period is recommended.

Substantial risk of recurrence even after 5 recurrence-free years in early-stage hepatocellular carcinoma patients

“…23,24 In a study of 1,058 patients receiving curative intent gastrectomy for T1-2N0 gastric adenocarcinoma in the United States and China, 7% of the patients experienced recurrences during a median follow-up of over 5 years, almost all of which occurred between 6 months and 3 years postoperatively. 25 There is no available evidence supporting routine surveillance for asymptomatic cancer recurrence after curative gastrectomy. Hence, routine intensive radiological evaluation or endoscopy for secondary cancer surveillance is not recommended, especially after 5 recurrence-free years.…”

Prognostic significance of preoperative CT findings in patients with advanced gastric cancer who underwent curative gastrectomy

“…A previously mentioned large retrospective study showed that tumor size ≥ 4.5 cm was significantly associated with worse overall survival in patients who underwent curative gastrectomy [ 8 ]. Tumor size was also one of the independent risk factors for disease recurrence among patients with T1-2 and lymph node-negative stomach cancer in the United States and China [ 23 ]. Additionally, macroscopic tumor size (≥7 cm) was one of the most important risk factors for peritoneal recurrence in patients with advanced stomach cancer who underwent adjuvant chemotherapy after D2 gastrectomy [ 24 ].…”

Current status and future prospects of clinical trials on CRS + HIPEC for gastric cancer peritoneal metastases

“…Several large-sample clinical studies across major regions of the world demonstrated that GC PM is a long-standing but ignored clinical problem (Table 1) [7][8][9][10][11]. These studies at different time periods and through different geographic regions have provided convincing evidence that PM is the most frequent and aggressive type of GC metastasis, and it remains the most important challenge in GC treatment.…”