Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2015; 21(19): 5934-5940
Published online May 21, 2015. doi: 10.3748/wjg.v21.i19.5934
Factors associated with early recurrence after curative surgery for gastric cancer
Wei-Ming Kang, Qing-Bin Meng, Jian-Chun Yu, Zhi-Qiang Ma, Zhi-Tian Li
Wei-Ming Kang, Jian-Chun Yu, Zhi-Qiang Ma, Zhi-Tian Li, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
Qing-Bin Meng, Department of Gastrointestinal Surgery, First Hospital of Wuhan City, Wuhan 430022, Hubei Provence, China
Author contributions: Kang WM and Meng QB contributed equally to this work both as the first author; Kang WM, Meng QB and Yu JC designed the research; Kang WM, Meng QB and Ma ZQ performed the research; Yu JC, Ma ZQ and Li ZT analyzed the data; Kang WM, Meng QB and Li ZT wrote the paper.
Supported by the Beijing Municipal Natural Science Foundation, No. 7132209; Capital Health Research and Development Special Fund, No. 2014-3-4014; Hubei Province Health and Family Planning Scientific Research Project, No. WJ2015MB137; Wuhan City Medical Research Project, No. WX15B14.
Ethics approval: The study was reviewed and approved by the Ethics Committee of Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College.
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: The authors have no conflicts of interest to declare.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jian-Chun Yu, MD, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No. 1 Shuai Fu Yuan, Dongcheng District, Beijing 100730, China. yu-jch@163.com
Telephone: +86-10-69152213 Fax: +86-10-69152213
Received: November 2, 2014
Peer-review started: November 2, 2014
First decision: November 27, 2014
Revised: January 7, 2015
Accepted: February 5, 2015
Article in press: February 5, 2015
Published online: May 21, 2015
Abstract

AIM: To characterize patterns of gastric cancer recurrence and patient survival and to identify predictors of early recurrence after surgery.

METHODS: Clinicopathological data for 417 consecutive patients who underwent curative resection for gastric cancer were retrospectively analyzed. Tumor and node status was reclassified according to the 7th edition of the American Joint Committee on Cancer tumor-node-metastasis classification for carcinoma of the stomach. Survival data came from both the patients’ follow-up records and telephone follow-ups. Recurrent gastric cancer was diagnosed based on clinical imaging, gastroscopy with biopsy, and/or cytological examination of ascites, or intraoperative findings in patients who underwent reoperation. Predictors of early recurrence were compared in patients with pT1 and pT2-4a stage tumors. Pearson’s χ2 test and Fisher’s exact test were used to compare differences between categorical variables. Survival curves were constructed using the Kaplan-Meier method and compared via the log-rank test. Variables identified as potentially important for early recurrence using univariate analysis were determined by multivariate logistic regression analysis.

RESULTS: Of 417 gastric cancer patients, 80 (19.2%) were diagnosed with early gastric cancer and the remaining 337 (80.8%) were diagnosed with locally advanced gastric cancer. After a median follow-up period of 56 mo, 194 patients (46.5%) experienced recurrence. The mean time from curative surgery to recurrence in these 194 patients was 24 ± 18 mo (range, 1-84 mo). Additionally, of these 194 patients, 129 (66.5%) experienced recurrence within 2 years after surgery. There was no significant difference in recurrence patterns between early and late recurrence (P < 0.05 each). For pT1 stage gastric cancer, tumor size (P = 0.011) and pN stage (P = 0.048) were associated with early recurrence of gastric tumors. Patient age, pT stage, pN stage, Lauren histotype, lymphovascular invasion, intraoperative chemotherapy, and postoperative chemotherapy were independent predictors of early recurrence in patients with pT2-4a stage gastric cancer (P < 0.05 each).

CONCLUSION: Age, pT stage, pN stage, Lauren histotype, lymphovascular invasion, intraoperative chemotherapy, and postoperative chemotherapy are independent factors influencing early recurrence of pT2-4a stage gastric cancer.

Keywords: Stomach neoplasms, Gastrectomy, D2 lymphadenectomy, Recurrence, Chemotherapy

Core tip: Few studies have assessed recurrence patterns or predictors of early recurrence after curative surgery in Chinese patients with gastric carcinoma. This study found that survival after gastric cancer recurrence was poor. Large tumor size and advanced pN stage were associated with early recurrence of tumor pT1 stage tumors. Age, pT stage, pN stage, Lauren histotype, lymphovascular invasion, intraoperative chemotherapy, and postoperative chemotherapy were independent predictors of early recurrence of pT2-4a stage tumors.