Abstract
BackgroundThe effect of long‐term surveillance for asymptomatic patients after curative resection of gastric cancer is being debated. We compared the prognosis of Korean patients with recurrent gastric cancer according to the presence or absence of cancer‐related symptoms at the time of recurrence detection.MethodsWe retrospectively reviewed the medical records of 305 Korean patients who experienced recurrence after curative resection of primary gastric cancer between March 2002 and February 2017 at Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.ResultsThe median follow‐up duration was 169.8 months (1–267.2), and the median age at first recurrence was 58.1 years (23.4–81.9). Among 305 patients with recurrence, 97 of 231 (42.0%) patients with early recurrence (≤5 years after curative surgical resection) and 47 of 74 (63.5%) patients with late recurrence (>5 years after curative surgical resection) had cancer‐related symptoms at recurrence (p = 0.001). For survival after recurrence, detection of asymptomatic recurrence was an independent favorable factor (hazard ratio, 0.527; 95% confidence interval, 0.409–0.681; p < 0.001) accompanied with the possibility of subsequent treatment, targeted‐, or immunotherapy for recurrent disease, and locoregional recurrence only. In the late‐recurrence group, the patients with asymptomatic detection of recurrence showed favorable post‐recurrence survival (median, 33.3 months vs. 14.7 months; p = 0.002), overall survival (median, 136.3 months vs. 106.1 months; p = 0.010), and cancer‐specific survival (median, 177.5 months vs. 106.1 months; p = 0.005) than the patients with symptomatic detection.ConclusionThe detection of gastric cancer recurrence in patients without cancer‐related symptoms may be related to improved survival, suggesting the potential benefit of long‐term surveillance.
Highlights
Despite the incidence and mortality rates of gastric cancer decreasing in recent decades, it is still one of the most common cancers, in East Asia.[1]
We demonstrated that the detection of gastric cancer recurrence after curative surgical resection in patients without cancer-related symptoms might be related to favorable overall survival (OS), Cancer-specific survival (CSS), and survival after recurrence in both the early-and late-recurrence groups
Active surveillance is recommended for the early detection of cancer recurrence after curative surgical resection
Summary
Despite the incidence and mortality rates of gastric cancer decreasing in recent decades, it is still one of the most common cancers, in East Asia.[1]. Due to the rapid increase in the number of gastric cancer survivors, there is a need to reconsider whether early detection of recurrence by active surveillance and subsequent cancer treatment might improve the survival of patients who underwent curative resection of primary gastric cancer. We analyzed whether the survival of patients with recurrent gastric cancer was different according to the presence or absence of cancer-related symptoms at the time of detection of recurrence. After completion of curative surgical resection and/or adjuvant treatment, patients visited the clinic They underwent routine follow-up evaluation following the institutional protocol, which consisted of history taking, physical examination, hematological and chemistry tests, tumor marker detection, anemia profiling, chest radiography, abdominopelvic computed tomography, or sonography, every 3 months for the first 2 years and every 6 months thereafter for 5 years. All statistical analyses were performed using SPSS 25 for Windows (IBM Corp.)
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