Author Reply: Follow-Up for Gastric Cancer: How Extensive and Intensive Should It Be?

Abstract

We appreciate the comments by Drs. Bali, Roukos, and Dr. Ziogas regarding our recently published article in the Annals of Surgical Oncology. To date, there have been no definite diagnostic methods established for recurrent gastric cancer, and recurrence has mostly been diagnosed using a combinatory analysis of several methods including computed tomography (CT), positron emission tomography (PET), tumor marker evaluation, and even diagnostic laparoscopy. Of these, CT has been the most popular method for detecting recurrent gastric cancer without invasiveness, although several reports have shown that CT is not specific for diagnosing recurrent tumors following curative gastric cancer surgery. However, our results indicated that CT is an essential follow-up method. Additional studies such as PET-CT or tumor marker identification require more clinical studies of their diagnostic accuracy and costeffectiveness before they can be established as follow-up methods. Based on our survey, follow-up studies after curative gastric cancer surgery are performed every 3 to 12 months with a physical examination and imaging methods in Korea. However, a consensus has not been reached for the optimal frequency of follow-up studies. Although patients with recurrent gastric cancer have poor outcomes, their prognoses have been improved using state-of-the-art treatments, such as new chemotherapeutic agents and molecular target therapy. Specifically, our previous study showed that complete resection of the metastatic lesion could lead to a better prognosis than other treatments. Therefore, early detection of recurrence by intensive follow-up can be meaningful. In addition, meta-analysis results of the cost effectiveness of follow-up studies after curative colorectal cancer surgery have revealed that intensive follow-up schedules were economically justified in the United Kingdom. However, there have been no studies performed to evaluate those after gastric cancer surgery. Randomized controlled clinical trials (RCTs) are needed to identify follow-up schedules that are optimal for patient survival and cost effectiveness between conventional and intensive follow-up strategies. In the future, extensive and intensive follow-up studies after curative gastric cancer surgery will be used according to the stage of the patient. Searching for gene mutations and tissue biomarkers may help to decide how extensive and intensive the follow-up studies should be to improve the prognosis of patients with recurrent gastric cancer. However, those issues should be discussed after routine follow-up schedules are established through additional clinical studies and well-designed randomized controlled clinical trials.