Abstract
BackgroundAdvanced gastric cancer frequently recurs even after radical resection followed by adjuvant chemotherapy. The aim of this study was to evaluate the relationship between pathological infiltrative pattern (INF) and initial recurrence patterns in patients with stage II/III gastric cancer using a large multicenter database.MethodsWe retrospectively analyzed 1098 eligible patients who underwent curative gastrectomy for stage II/III gastric cancer at nine institutions between 2010 and 2014. Patients were categorized into the INF‐a/b and INF‐c groups and adjusted using propensity score matching.ResultsAfter propensity score matching, 686 patients (343 for each) were classified in the INF‐a/b and INF‐c groups. There were no significant differences in overall and disease‐free survival between the two groups. In the INF‐a/b group, frequencies of recurrence at the peritoneum, lymph node, and liver were equivalent. In contrast, the peritoneum was the most frequent site and accounted for 60% of the total recurrences in the INF‐c group. The cumulative peritoneal recurrence rate was significantly higher in the INF‐c group than in the INF‐a/b group (hazard ratio 2.47). INF‐c was a significant risk factor for peritoneal recurrences in most subgroups including age, sex, macroscopic type, tumor differentiation, and disease stage, and whether the postoperative treatment was given. Multivariate analysis identified INF‐c as an independent risk factor for peritoneal recurrences. The cumulative liver recurrence rate was significantly higher in the INF‐a/b group than in the INF‐c group (hazard ratio 3.44).ConclusionsINF may represent an important predictor of recurrence patterns after curative resection of stage II/III gastric cancer.
Highlights
Gastric cancer is a common malignant tumor that is the second cause of all cancer deaths worldwide.[1]
We recently reported that the pathological infiltrative pattern (INF) was closely related to sites of initial recurrence after curative resection of gastric cancer.[5]
The cumulative peritoneal recurrence rate was significantly higher in the INF‐c group than in the INF‐a/b group (HR 2.47, 95% CI 1.62‐3.88, P < 0.0001; Figure 2B)
Summary
Gastric cancer is a common malignant tumor that is the second cause of all cancer deaths worldwide.[1]. The study suffered from several limitations including being a single institution study with a small sample size, using patient data obtained over a prolonged period, and clinicopathologic differences between the patient groups that were compared. We selected 1098 patients for analysis according to the following inclusion criteria: no preoperative treatment, R0 gastrectomy with systematic lymphadenectomy performed according to the Japanese Gastric Cancer Treatment Guidelines,[6] pathologically diagnosed as stage II or III gastric cancer according to the TNM Classification of Malignant Tumors, 8th Edition,[7] and sufficient data for analysis (Figure 1A). Patients underwent gastrectomy with systematic lymphadenectomy according to the Japanese Gastric Cancer Treatment Guidelines,[6] and the reconstruction method was selected at the surgeon’s discretion.
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