Abstract
BackgroundIn most western European countries perioperative chemotherapy is a part of standard curative treatment for gastric cancer. Nevertheless, recurrence rates remain high after multimodality treatment. This study examines patterns of recurrence in patients receiving perioperative chemotherapy with surgery for gastric cancer in a real-world setting.MethodsAll patients diagnosed with gastric adenocarcinoma between 2010 and 2015 who underwent at least preoperative chemotherapy and a gastrectomy with curative intent (cT1N+/cT2-4a,X; any cN; cM0) in 18 Dutch hospitals were selected from the Netherlands Cancer Registry. Additional data on chemotherapy and recurrence were collected from medical records. Rates, patterns, and timing of recurrence were examined. Multivariable Cox proportional hazard analyses were used to determine prognostic factors for recurrence.Results408 patients were identified. After a median follow-up of 27.8 months, 36.8% of the gastric cancer patients had a recurrence of which the majority (88.8%) had distant metastasis. The 1-year recurrence-free survival was 71.8%. The risk of recurrence was higher in patients with an ypN+ stage (HR 4.92, 95% CI 3.35–7.24), partial or no tumor regression (HR 2.63, 95% CI 1.22–5.64), 3 instead of ≥ 6 chemotherapy cycles (HR 3.04, 95% CI 1.99–4.63), R1 resection (HR 1.52, 95% CI 1.02–2.26), and < 15 resected lymph nodes (HR 1.64, 95% CI 1.14–2.37).ConclusionA considerable amount of gastric cancer patients who were treated with curative intent developed a recurrence despite surgery and perioperative treatment. The majority developed distant metastases, therefore, multimodality treatment approaches should be focused on the prevention of distant rather than locoregional recurrences to improve survival.
Highlights
Gastric cancer is the fourth most common malignancy and the second leading cause of cancer death worldwide [1, 2]
recurrence-free survival (RFS) was defined as the interval between the date of initial operation and the date of recurrence, or death of any cause, or last follow-up
This study identified age above 60, R1 resection margin, ypN+ tumor stage, diffuse type tumors, partial or no tumor regression, and no postoperative therapy as independent associated factors with a higher chance on recurrence
Summary
Gastric cancer is the fourth most common malignancy and the second leading cause of cancer death worldwide [1, 2]. In most western European countries perioperative chemotherapy is a part of standard curative treatment for gastric cancer. Recurrence rates remain high after multimodality treatment. This study examines patterns of recurrence in patients receiving perioperative chemotherapy with surgery for gastric cancer in a real-world setting. The risk of recurrence was higher in patients with an ypN+ stage (HR 4.92, 95% CI 3.35–7.24), partial or no tumor regression (HR 2.63, 95% CI 1.22–5.64), 3 instead of ≥ 6 chemotherapy cycles (HR 3.04, 95% CI 1.99–4.63), R1 resection (HR 1.52, 95% CI 1.02–2.26), and < 15 resected lymph nodes (HR 1.64, 95% CI 1.14–2.37). Conclusion A considerable amount of gastric cancer patients who were treated with curative intent developed a recurrence despite surgery and perioperative treatment. The majority developed distant metastases, multimodality treatment approaches should be focused on the prevention of distant rather than locoregional recurrences to improve survival
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