Recurrence patterns of gastric cancer in the era of preoperative therapy.

Abstract

119 Background: The purpose of this study was to determine the disease sites and survival durations of patients who developed a recurrence after undergoing gastrectomy for adenocarcinoma. Methods: We collected data from a prospectively maintained database of gastric cancer patients who underwent potentially curative resection of gastric or gastroesophageal cancer at our institution from 1995-2014. Univariate and multivariate analyses were performed to determine the associations between clinicopathologic factors and treatment outcomes. Results: We identified 488 patients who underwent R0 resection of localized gastric cancer. The median age was 63 years (IQR, 53-71 years), and 60% were male. The most common EUS stages were T3 (58%) and N0 (61%). Preoperative treatment was used in 61% of patients. The majority (76%) of patients underwent extended (D1+/D2) lymphadenectomy, and the median number of examined lymph nodes was 21 (IQR, 14-29). Of the 488 patients, 125 (26%) experienced recurrence during follow up. The sites of recurrence were locoregional (n = 19 [15%]), peritoneal (n = 61 [49%]), and non-peritoneal distant at any site (n = 67 [53.6%]). The site of recurrence was not associated with neoadjuvant therapy (p = 0.35). The median time from the primary resection to recurrence was 2.7 years (95% CI, 0.8-3.2 years) for locoregional, 1.3 (0.7-1.7) for peritoneum, and 0.6 (0.5-0.9) for distant disease (p = 0.01). The median overall survival time from recurrence was 1.0 year (95% CI, 0.5-3.1 years) for locoregional, 0.6 (0.4-0.9) for peritoneum, and 0.8 (0.5-1.0) for distant recurrence (p = 0.05). A multivariate analysis revealed that age ≥ 65 years (HR, 1.52 [95% CI, 1.12-2.05 years]; p = 0.01) and advanced EUS T stage (3.06 [2.10-4.46]; p < 0.001) were associated with a shorter recurrence-free survival duration. Conclusions: Peritoneal carcinomatosis was the most common site of recurrence after curative resection of gastric cancer, with associated poor survival, and was not associated with the use of neoadjuvant therapy. Future trials should focus on treatment of the peritoneum, which may improve the survival of patients with advanced gastric cancer.