Abstract
BackgroundRecurrence patterns in patients who have undergone curative gastrectomy for advanced gastric carcinoma can be classified as peritoneal, hematogenous, or lymphatic. The aim of this study was to clarify differences in risk factors between these different types of recurrence pattern.MethodsPostoperative courses, including sites of recurrence and periods between surgery and recurrence, of patients who had undergone curative gastrectomy for advanced gastric carcinoma (more than pT2 invasion) were surveyed in detail. Clinicopathological factors were examined as potential independent risk factors for each recurrence pattern, based on recurrence-free survival, using multivariate analysis.ResultsMultivariate analysis identified depth of tumor invasion (pT4 vs. pT2/3; hazard ratio (HR), 7.05; P < 0.001), number of lymph node metastases (pN2/3 vs. pN0/1; HR, 4.02; P = 0.001), and histological differentiation (G3/4 vs. G1/2; HR, 2.22; P = 0.041) as independent risk factors for peritoneal metastasis. The number of lymph node metastases (HR, 26.21; P < 0.001) and venous vessel invasion (HR, 5.09; P = 0.001) were identified as independent risk factors for hematogenous metastasis. The number of lymph node metastases (HR, 6.00; P = 0.007) and depth of tumor invasion (HR, 4.70; P = 0.023) were identified as independent risk factors for lymphatic metastasis.ConclusionsThis study clarified differences in risk factors between various patterns of recurrence. Careful examination of risk factors could help prevent oversight of recurrences and improve detection of recurrences during follow-up. The number of lymph node metastases represents an independent risk factor for all three patterns of recurrence; thus, patients with multiple lymph node metastases warrant particular attention.
Highlights
Recurrence patterns in patients who have undergone curative gastrectomy for advanced gastric carcinoma can be classified as peritoneal, hematogenous, or lymphatic
Clinicopathological factors This study examined eight clinicopathological factors as candidate risk factors for recurrence after curative resection of advanced gastric carcinoma: extent of the primary tumor; number of metastatic lymph nodes; histopathological grading (G1/2, including papillary carcinoma, vs. G3/4, including signet ring cell carcinoma, mucinous adenocarcinoma, in accordance with the TNM Classification of Malignant Tumors [2]); venous invasion; lymphatic vessel invasion; sex; age (
Recurrence patterns Among the 132 patients who underwent curative resection for advanced gastric carcinoma, 66 were alive without recurrence and 6 were alive with recurrence of gastric carcinoma, as of March 2012, while 21 patients had died of other diseases without evident recurrence of gastric carcinoma and 39 had died of recurrent gastric carcinoma
Summary
Recurrence patterns in patients who have undergone curative gastrectomy for advanced gastric carcinoma can be classified as peritoneal, hematogenous, or lymphatic. The aim of this study was to clarify differences in risk factors between these different types of recurrence pattern. Even after performing curative surgical resection, death from recurrence is frequent among patients with advanced gastric carcinoma. Early detection of recurrence sites is sometimes difficult. One reason for this is that recurrence can show various patterns. Recurrence patterns in patients who have undergone curative surgical resection for advanced gastric carcinoma can be classified as peritoneal, hematogenous, or lymphatic. The aim of this study, was to clarify differences in risk factors between these three recurrence patterns among patients who had undergone curative resection for advanced gastric carcinoma
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