Timing of Death From Tumor Recurrence After Curative Gastrectomy for Gastric Cancer

Abstract

In Western literature, there are few studies investigating the predictors of early versus late recurrence after curative gastrectomy for gastric cancer. The current study analyzed (1) patients who died of recurrent gastric cancer and (2) prognostic factors, which can be applied to timing of death from tumor recurrence. Of 492 patients who underwent curative resection (R0) for gastric cancer in the Department of Surgery, Medical Faculty of Istanbul between 1994 and 2000, 142 patients who died of recurrence were included into study. None of the patients had received postoperative adjuvant treatment. The patients were divided into 2 groups: an early recurrence group that included 102 patients who recurred and died within 2 years after surgery, and a late recurrence group, which included 40 patients who died of recurrence more than 2 years after surgery. Clinicopathologic findings were compared between the early and late recurrence groups. Multivariate analysis was performed to investigate the independent factors, which are predictive for early versus late recurrence, and prognostic factors independently associated with the survival period. In multivariate analysis, the early recurrence group, when compared with the late recurrence group, was characterized by lymph node metastasis (N1-3 versus N0; P = 0.002). Overall survival was influenced by nodal status (N1-3 versus N0; P = 0.003), type of operation performed (radical total versus radical subtotal gastrectomy; P = 0.003), Eastern Cooperative Oncology Group performance status (PS 3-4 versus PS 1-2; P = 0.004), and tumor localization (cardia versus corpus and antrum; P = 0.046). In contrast, T stage of the disease was not prognostic for survival, although it was close to statistical significance (P = 0.066). Multivariate analysis showed that poorer performance status at initial presentation (P = 0.001) and lymph node metastasis (P = 0.032) independently correlated with overall survival (P = 0.002). Lymph node status was the most important factor predictive for early versus late recurrence and patients with lymph node metastases were at more risk of death within 2 years after curative operation for gastric cancer. Postoperative chemoradiotherapy should be especially recommended for patients at high risk of recurrence of adenocarcinoma of the stomach or who have undergone curative resection.

Comparison the sixth and seventh editions of the AJCC staging system for T1 gastric cancer: a long-term follow-up study of 2124 patients

“…Early tumor recurrence has been associated with lymph node metastasis and a poor prognosis [7,16,17]. In our study we observed that tumor recurrence and prognosis of T1a (tumor invades mucosa) cancer were similar to those for T1b (tumor invades submucosa) cancer (p [ 0.05), and we identified lymph node metastasis as an independent risk factor for tumor recurrence, as well as an independent prognostic factor.…”

Factors associated with early recurrence after curative surgery for gastric cancer

“…Many studies have reported that approximately 70% of patients with gastric cancer experience early tumor recurrence, defined as within 2 years after surgery [9,11,24] . Less is known, however, about patterns of recurrence and predictors of early recurrence, especially in Chinese patients.…”

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

“…Such minute invasion of the serosa which could not be detected by routine staging procedures might have led to the peritoneal recurrence. With regard to the correlation between risk factors for recurrence and clinicopathological factors, a number of risk factors have been identified for all stages of gastric cancer; these include lymph node metastasis and performance status [4][5][6]. Furthermore, a few researchers have examined the risk factors of early gastric cancer in more detail.…”

“…To determine the independent risk factors involved in the recurrence of stage Ib gastric cancer, significant factors identified by univariate analysis (gender, histological type) and the variables found to be of importance in previous studies (lymph node metastasis, lymphatic and vascular invasion, gross appearance) [4][5][6][7][8][9][10] were subjected to logistic regression analysis (Table 3). It was revealed that the only independent risk factor for recurrence was histologically undifferentiated-type adenocarcinoma (p = 0.0069).…”

“…Although a number of risk factors have been identified for all stages of gastric cancer [4][5][6], because of the relatively low incidence of recurrence after curative resection for stage Ib gastric cancer, the risk factors and rates of recurrence for this stage are unclear.…”