Curative Resection For Gastric Adenocarcinoma Research Articles

Dynamic Prediction of Survival after Curative Resection of Gastric Adenocarcinoma: A landmarking-based analysis

BackgroundAccurate estimation of survival and recurrence are important to inform decisions regarding therapy and surveillance. We sought to design and validate a dynamic prognostic model for patients undergoing resection for gastric adenocarcinoma. MethodsPatients who underwent curative-intent surgery for gastric adenocarcinoma between 2000 and 2020 were identified using a multi-institutional database. Landmark analysis was used to create dynamic OS and DFS prediction models. Model performance was internally cross-validated via bootstrap resampling. ResultsAmong 895 patients, 507 (57.2%) patients underwent partial gastrectomy (n = 507, 57.2%) while 380 (42.8%) had total gastrectomy. Median tumor size was 40 mm (IQR: 25–65), most tumors were located in the antrum (n = 344, 39.5%) and infiltrated the subserosa (T3 tumors: n = 283, 31.9%) or serosa (T4 tumors: n = 253, 28.5%); lymph node metastasis occurred in 528 (59.1%) patients. Median OS and DFS were 17.5 (IQR: 7.5–42.8) and 14.3 months (IQR: 6.5–39.9), respectively. The impact of age, sex, preoperative comorbidities, tumor size and location, extent of lymphadenectomy and total number of lymph nodes examined, Lauren class, T and N category, postoperative complications, and tumor recurrence varied over time (all p < 0.05). An online tool to predict dynamic OS and DFS based on patient survival relative to time survived was developed and made available for clinical use. Discrimination ability of OS and DFS was excellent (C-index: 0.84 and 0.86, respectively) and calibration plots revealed good prediction. ConclusionsAn online dynamic prognostic tool was developed and validated to predict OS and DFS following resection of gastric adenocarcinoma. Landmark analysis to predict long-term outcomes based on follow-up time may be helpful to surgeons and patients.

Prediction of long-term survival after gastrectomy using random survival forests.

No well validated and contemporaneous tools for personalized prognostication of gastric adenocarcinoma exist. This study aimed to derive and validate a prognostic model for overall survival after surgery for gastric adenocarcinoma using a large national dataset. National audit data from England and Wales were used to identify patients who underwent a potentially curative gastrectomy for adenocarcinoma of the stomach. A total of 2931 patients were included and 29 clinical and pathological variables were considered for their impact on survival. A non-linear random survival forest methodology was then trained and validated internally using bootstrapping with calibration and discrimination (time-dependent area under the receiver operator curve (tAUC)) assessed. The median survival of the cohort was 69 months, with a 5-year survival of 53.2 per cent. Ten variables were found to influence survival significantly and were included in the final model, with the most important being lymph node positivity, pT stage and achieving an R0 resection. Patient characteristics including ASA grade and age were also influential. On validation the model achieved excellent performance with a 5-year tAUC of 0.80 (95 per cent c.i. 0.78 to 0.82) and good agreement between observed and predicted survival probabilities. A wide spread of predictions for 3-year (14.8-98.3 (i.q.r. 43.2-84.4) per cent) and 5-year (9.4-96.1 (i.q.r. 31.7-73.8) per cent) survival were seen. A prognostic model for survival after a potentially curative resection for gastric adenocarcinoma was derived and exhibited excellent discrimination and calibration of predictions.

Health-related quality of life after curative resection for gastric adenocarcinoma.

BACKGROUNDWith improved survival in gastric cancer patients, health-related quality of life has become an important clinical endpoint alongside primary oncological outcomes.AIMTo investigate health-related quality of life after various surgical procedures for gastric cancer treatment.METHODSThe validated Slovenian version of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (QLQ-C30) and its gastric cancer-specific module (QLQ STO-22) was sent for self-completion to patients that underwent curative resection for gastric adenocarcinoma between January 2014 and December 2018 at our centre. In total, 116 patients responded. Scores were compared between patients after subtotal distal vs total gastrectomy and patients after subtotal distal gastrectomy with Billroth II vs Roux-en-Y reconstruction.RESULTSInterestingly, the extent of resection did not influence daily functioning; however, more dysphagia and eating restrictions were reported in patients after total gastrectomy when compared to patients after subtotal distal gastrectomy. Moreover, patients with Billroth II reconstruction after subtotal distal resection experienced worse physical and role functioning and reported more pain, fatigue and reflux compared to Roux-en-Y reconstruction.CONCLUSIONBased on our results, Roux-en-Y reconstruction after subtotal distal gastrectomy should be preferred over Billroth II reconstruction. The data obtained from this study will help surgeons when preoperatively informing their patients about expected functional outcomes after gastrectomy and enable them to ensure proper supportive care of their patients in the postoperative period.

External validation of the new prognostic western score in predicting survival after curative resection of gastric cancer

Aim: Gastric cancers may progress differently depending on the factors affecting the prognosis. In our study, we evaluated the external validation of the new prognostic western score used to predict the surveillance of gastric cancer patients undergoing curative resection.&#x0D; Material and methods: The study included 139 patients over 18 years of age who underwent curative resection for gastric adenocarcinoma in our hospital between 2004 and 2015. The demographic characteristics of the patients and their albumin level, neutrophil lymphocyte ratio and pathological tumor-nodes-metastasis stage were evaluated.&#x0D; Results: Fifty-nine (42.4%) of the patients were female and 80 (57.6%) were male. The mean albumin value was 39±7 mg/L, and the median value of the neutrophil/lymphocyte ratio was 2.5 (1.76-4). According to the pathological tumor-nodes-metastasis staging, 13 cases (9.4%) were stage 1, 21 (15.1%) stage 2, 99 (71.2%) stage 3, and 6 (4.3%) stage 4. The five-year median survival of the patients was 32.5 months. Age was significantly higher in the mortality group (P=.021). In the log-rank analysis, a low albumin level, a high neutrophil lymphocyte ratio, and a high tumor-nodes-metastasis stage were statistically significant in the mortality group (P=.001, .000 and .030 respectively). In the Cox regression analysis, the only significant variable was determined as pathological stage (P=.005).&#x0D; Conclusion: The new prognostic western score was not significant in predicting the prognosis of gastric cancers.

Perioperative outcomes and survival in elderly patients aged ≥ 75years undergoing gastrectomy for gastric cancer: an 18-year retrospective analysis in a single Western centre.

Surgical resection for elderly patients with gastric cancer is controversial. This study aims to evaluate the preoperative features and postoperative short- and long-term outcomes of elderly patients following surgical resection for gastric adenocarcinoma. Between January 2000 and May 2018, a total of 177 consecutive patients underwent curative gastrectomy for gastric adenocarcinoma was retrospectively reviewed. Propensity score matching (PSM) analysis was used to balance confounding covariates between the elderly and non-elderly groups. Clinicopathological characteristics, intraoperative characteristics, postoperative complicationsand long-term survival outcomes including overall survival (OS) and Disease Specific Survival (DSS) were compared and analysed using the Kaplan-Meier log-rank test. Multivariate cox proportional hazards regression analysis of clinicopathological factors influencing survival wereevaluated. There were 50 patients in the elderly group (age ≥ 75years) and 127 patients in the non-elderly group (age < 75years). Elderly patients had more comorbid conditions (p < 0.001), lower albumin concentration (p = 0.034), lower haemoglobin levels (p = 0.001), and poorer renal function (p = 0.043). TNM stage was similar between both groups (p = 0.174); however, lymphatic invasion (p = 0.006) and lymph node metastasis (p = 0.029) were higher in the elderly group. Elderly patients were much less likely to receive any chemo- (p < 0.001) or radiotherapy treatment (p = 0.007) with surgical treatment. After PSM, there were 50 patients in each group. Elderly patients were more likely to develop complications (Clavien Dindo ≥ 2: 50% vs. 26%, p = 0.003). The most common postoperative complications were pneumonia (12% vs. 6%, p = 0.498) and delirium (10% vs. 0%, p = 0.066). Elderly patients had a longer median length of hospital stay (median (IQR): 15.6(9.5) vs. 11.3 (9.9), p = 0.030). There were no differences in 30-day mortality (elderly vs. non-elderly: 1% vs. 1%, p = 0.988). Before and after PSM,age remains an independent predictor of postoperative complications. Before PSM,the estimated mean OS for the elderly and non-elderly patients were 108months (95%CI, 72.5-143.5) and 143months (95%CI, 123.0-163.8), respectively (p = 0.264). After PSM, the estimated mean OS for the elderly and non-elderly patients were 108 months (95%CI, 72.5-143.5) and 140 months (95%CI, 112.1-168.2), respectively, (p = 0.360). Before PSM,the estimatedmean DSS for the elderly and non-elderly patients were 94months (95%CI, 61.9-127.5) and 121months (95%CI, 100.9-141.0), respectively (p = 0.405). After PSM, the estimated mean DSS for the elderly and non-elderly patients were 94months (95%CI, 61.9-127.5) and 115 months (95%CI, 87.3-143.3), respectively (p = 0.721). Age was not an independent predictor of mortality following gastrectomy for gastric cancer in both PSM matched and unmatched cohort. Chronological age alone is not a contraindication to curative resection of gastric adenocarcinoma in elderly patients with acceptable risk. Whilst age affects perioperative complications, the incidence of postoperative mortality and overall survival were not significantly different between elderly and non-elderly gastric cancer patients treated with curative surgery. Gastrectomy with D2 lymphadenectomy can also be performed in carefully selected elderly patients by surgeons with expertise in gastric resection along with appropriate perioperative management.

Reappraise role of lymph node status in patterns of recurrence following curative resection of gastric adenocarcinoma.

ObjectiveTo examine the association between lymph node status and recurrence patterns in completely resected gastric adenocarcinoma.MethodsWe retrospectively assessed 1,694 patients who underwent curative gastrectomy from January 2010 to August 2014. Patients stratified according to lymph node status and recurrence patterns among different subgroups were compared.ResultsOf all, 517 (30.5%) patients developed recurrent disease, and complete data of recurrence could be obtained in 493 (95.4%) patients. For pN0 patients, the patterns of recurrence were different according to pT stage: locoregional recurrence was most common in patients with pT1−2 disease (57.1%), distant recurrence was most common in patients with pT3 disease (57.1%), and peritoneal recurrence was most common in patients with pT4a disease (66.7%). For pN+ patients, distant metastasis was most common pattern irrespective of pT stage. The site-specific trend of recurrence showed that locoregional recurrence increased within 5 years in patients with pN0−2 disease but plateaued 3 years after surgery in patients with pN3 disease. Time to recurrence was significantly longer for the pN0 patients compared with the pN+ patients (median: 25 vs. 16 months, P=0.001). Moreover, post-recurrence survival was significantly better for the pN0 patients than for the pN+ patients (median: 12 vs. 6 months, P<0.001), especially in patients with non-peritoneal recurrence, late recurrence, single recurrence, and receipt of potential curative treatment. ConclusionsAmong clinicopathologic factors, lymph node status is the most important factor associated with recurrence patterns after curative gastrectomy. Lymph node status may be used as an adjunct in clinical decision-making about postoperative therapeutic and follow-up strategies.

143P Lymph nodes metastasis is the most important factor associated with pattern of recurrence following curative resection of gastric adenocarcinoma

Lymph node status is among the most important predictors of recurrence after curative gastrectomy. However, the impact of lymph node status on recurrence patterns remains unclear. We aimed to analyse recurrence patterns in completely resected gastric cancer (GC) with negative (pN0) or positive (pN+) lymph nodes. We retrospectively assessed 1694 patients who underwent curative gastrectomy from January 2010 to August 2014. Patients were divided into pN0(n=655) and pN+(n=1039) cohorts. Timing and site(s) of recurrence were examined. Of all,517(30.5%) patients developed recurrent disease, and complete data on recurrence could be obtained in 493 patients.For the pN0 cohort, the patterns of recurrence were different according to pT stage: locoregional recurrence was the most common in patients with pT1-2 disease (57.1%), distant was the most common in patients with pT3 disease (57.1%), and peritoneal was the most common in patients with pT4a disease (66.7%). For the pN+ cohort, distant metastasis was the most common pattern irrespective of pT stage. The site-specific trend of recurrence showed that locoregional recurrence increased within 5 years in patients with pN0-2 disease but plateaued 3 years after surgery in patients with pN3 disease. Time to recurrence was significantly longer for the pN0 cohort compared with the pN+ cohort (median:25 vs 16 months=0.001). Moreover, post-recurrence survival was significantly better for the pN0 cohort than for the pN+ cohort (median:12 vs 6 months<0.001), especially in patients with non-peritoneal recurrence, late recurrence, single recurrence, and receipt of potential curative treatment. There was a significant difference in recurrence patterns survival between node-negative and node-positive patients. For node-negative patients, follow-up strategies should be considered according to pathologic T stage, while the key to follow-up for node-positive patients is distant metastasis.

Impact of intraoperative staging of gastric cancer on long-term survival.

302 Background: The preoperative stage and intraoperative stage of gastric cancer were unified as the clinical stage in the 8th edition of the TNM classification (UICC). Although there are some reports about the relationship between preoperative stage and prognosis, the relationship between intraoperative stage and prognosis remains unclear. The aim of this study was to clarify the impact of intraoperative diagnosis and staging on long-term survival. Methods: Overall survivals were examined in 915 patients who underwent curative resection for gastric adenocarcinoma between April 2011 and March 2019 in our hospital. Results: The median age of the patients was 69 years (27-90 years), including 585 male and 330 female. The median follow-up period was 33.6 months (0.1-86.7 months). The number of the patients according to intraoperative stage were 641(70.1 %) in stageI, 15(1.6%) in stageIIA, 135(14.8%) in stageIIB, 111(12.1%) in stageIII, 12(1.3%) in stageIVA and 1(0.1%) in stageIVB. The hazard ratios of intraoperative stage for overall survival were as follows (ref: StageI); StageIIA, 6.990 (95% CI: 2.473-19.760, p &lt; 0.001), StageIIB, 2.234 (95% CI: 1.220-4.092, p = 0.009), StageIII, 4.091 (95% CI: 2.416-6.928, p &lt; 0.001), StageIVA, 6.061 (95% CI: 2.150-17.080, p &lt; 0.001), StageIVB, 14.92 (95% CI: 2.035-109.3, p = 0.008). Conclusions: The survival of intraoperative StageIIA was poorer than StageIIB/III. Intraoperative positive lymph node metastasis could be negative impact of survival, even if tumor invasion was T1 or T2.

Comparative Effectiveness of Lymphadenectomy Strategies During Curative Resection for Gastric Adenocarcinoma

BackgroundThe purpose of this study was to compare the long-term effectiveness of three lymphadenectomy strategies in patients with gastric cancer. We hypothesized that, compared with the traditional standard (D2) lymph node dissection strategy, the less aggressive modified standard (mD2) lymphadenectomy may offer superior effectiveness due to reduced operative morbidity and comparable long-term recurrence-free survival. MethodsA Markov decision analysis model was created to simulate 5-year outcomes across three lymphadenectomy approaches for gastric cancer: limited regional (D1), traditional standard (D2), and modified standard (mD2). The primary outcome was discounted quality-adjusted life-years (dQALY). Model variable estimates were derived from outcomes data and quality of life estimates published in Europe and America within the last 15 years. One-way and probabilistic sensitivity analyses were performed for clinically relevant variables. ResultsThe mD2 lymphadenectomy offered 3.03 dQALY over 5 years, outperforming D2 (2.62 dQALY) and D1 (2.37 dQALY). Monte Carlo simulations indicated that both mD2 and D2 lymph node dissection strategies outperformed D1 in 94.9% of simulations. Sensitivity analyses demonstrated that the mD2 approach would be less effective than D2 if the perioperative mortality rate of mD2 was greater than 6.9% (3.2% baseline). ConclusionsAcross modern series, the modified standard mD2 lymphadenectomy is an effective alternative to the traditional D2 lymphadenectomy for patients with gastric cancer. A D1-limited regional lymphadenectomy is not recommended during gastric cancer resection.

Can recurrence patterns after curative resection for gastric adenocarcinoma (GCa) inform the selection of adjuvant treatment?

136 Background: Despite improvements in multidisciplinary care and surgical technique, ≈40% of patients recur after curative resection for GCa. Adjuvant treatment decisions should be informed by the expected timing and site of failure, but accurate data are limited. The aim of our study was to describe and analyze the patterns of recurrence at our center. Methods: Patients who underwent curative intent margin-negative resection from 2006-16 were identified from a prospective GCa database. Date of first detection and site of recurrence were determined. Survival curves were calculated by the KM method. Univariate and multivariable analyses (MVA) were performed to identify predictive variables. Significance was set at p &lt; 0.05. Results: Of 123 patients who met inclusion criteria, median age was 70 yrs, 37% were female, and median follow-up after resection was 24 mos (IQR 11-40). Five-year OS was 72% and RFS 69%. In 34 of 36 patients who recurred, recurrence was detected within 2 yrs. Receipt of adjuvant therapy (Macdonald or MAGIC) was associated with better 5-year OS and RFS than surgery alone (79% vs. 60%, 77% vs. 60%) and delayed time to recurrence (median 10.4 vs. 7.1 mos). Receipt of CRT by the Macdonald protocol appeared to lower the risk of locoregional recurrence vs. surgery alone (see Table) despite routine D2 lymphadenectomy. On MVA, recurrence at any site was predicted by age £ 60y (OR 3.8), male gender (4.0), and AJCC stage &gt; II (4.6). Peritoneal recurrence was predicted only by age £ 60y (3.2). Conclusions: Recurrence after curative resection occurred within 2 yrs of resection. Locoregional recurrence was uncommon in patients who received postoperative CRT. Peritoneal recurrence, which might be abrogated by prophylactic HIPEC at the time of resection, is not well explained by clinicopathologic variables, and novel molecular predictors are required. [Table: see text]

Effect of total number of harvested lymph nodes on survival outcomes after curative resection for gastric adenocarcinoma: findings from an eastern high-volume gastric cancer center

BackgroundGreater lymph node retrieval in gastric cancer improves staging accuracy and may improve survival from increased clearance of nodal micrometastasis. This retrospective cohort study investigated if more lymph nodes removed in gastric cancer increases survival and if such effect is stage-specific due to differential risks of nodal micrometastasis and systemic disease.MethodsThe prospectively collected database of curatively resected gastric cancer patients in National Cancer Center, South Korea between 2000 and 2009 was reviewed. Disease-free survival (DFS) and overall survival (OS) for all patients and for each stage according to number of lymph nodes examined (1–30, 31–45, > 45) were analyzed.ResultsOf 4049 patients, 96.6% and 98.4% underwent D2 (perigastric and extragastric) lymphadenectomy and had ≥ 15 lymph nodes examined. Mean number of nodes examined was 43. Five-year OS & DFS rates were 83.3% and 80.7%. Patients with > 45 nodes examined had significantly lower DFS (p = 0.002) and OS (p = 0.007) compared to those with 1–30 and 31–45 nodes. However, proportion of patients with > 45 nodes examined increased with stage (p = 0.0005). Per stage, there was no significant difference in DFS and OS according to number of nodes examined except for stage IIIA favoring more nodes (p = 0.018 and p = 0.044, respectively). Similar trend was seen in stage IIB. Number of examined nodes positively correlated with number of pathologic nodes for all patients (r = 0.144, p < .001) but not for stage IIB and IIIA. Number of nodes examined was a significant survival predictor in stage IIIA.ConclusionGreater lymph node harvest showed improved survival in intermediate-stage gastric cancer.

The prognostic value of different node staging systems in patients with ≤15 lymph nodes following surgery for gastric adenocarcinoma

Aim: Lymph node (LN) status is an important prognostic indicator in patients with gastric cancer (GC). Although American Joint Committee on Cancer/International Union against Cancer (AJCC/UICC) is the most widely used staging system, there is a challenge in predicting survival of patients when the number of total harvested LNs is ≤15. Our aim was to investigate the prognostic performances of seventh edition AJCC/UICC, lymph-node ratio (LNR), and log odds of metastatic lymph nodes (LODDS) on the overall survival (OS) of GC patients with ≤15 examined LNs after gastric resection.Material and method: A total of 74 patients who underwent curative resection for gastric adenocarcinoma and had ≤15 LNs at the final histopathological examination were included in the study. The prognostic ability of three node staging models to predict OS was assessed using the area under the curve (AUC).Results: Of the 74 patients, 15 (20.3%) had no LN metastasis whereas 59 (79.7%) had nodal involvement. The median OS was 26 months. When assessed as a continuous variable, LNR was the strongest staging system to stratify GC patients on the basis of LN status. LODDS had superiority on other node staging models when the number of LNs retrieved was modeled as categorical variable.Conclusions: LNR (continuous) and LODDS (categorical) were the strongest indicators of OS in GC when the number of LN harvested was ≤15. Therefore, they may be considered as an alternative nodal staging systems for GC.

Mo1380 Patterns of Initial Recurrence After Curative Resection for Gastric Adenocarcinoma According to Lauren Histologic Type

Mo1380 Patterns of Initial Recurrence After Curative Resection for Gastric Adenocarcinoma According to Lauren Histologic Type

Interaction of Postoperative Morbidity and Receipt of Adjuvant Therapy on Long-Term Survival After Resection for Gastric Adenocarcinoma: Results From the U.S. Gastric Cancer Collaborative.

Postoperative complications (POCs) can negatively impact survival after oncologic resection. POCs may also decrease the rate of adjuvant therapy completion. We evaluated the impact of complications on gastric cancer survival and analyzed the combined effect of complications and adjuvant therapy on survival. We analyzed 824 patients from 7 institutions of the U.S. Gastric Cancer Collaborative who underwent curative resection for gastric adenocarcinoma between 2000 and 2012. POC were graded using the modified Clavien-Dindo system. Survival probabilities were estimated using the method of Kaplan and Meier and analyzed using multivariate Cox regression. Median follow-up was 35months. The overall complication rate was 41%. The 5-year overall survival (OS) and recurrence-free survival (RFS) of patients who experienced complications were 27 and 23%, respectively, compared with 43 and 40% in patients who did not have complications (p<0.0001 for OS and RFS). On multivariate analysis, POC remained an independent predictor for decreased OS and RFS (HR 1.3, 95% CI 1.1-1.6, p=0.03 for OS; HR 1.3, 95% CI 1.01-1.6, p=0.03 for RFS). Patients who experienced POC were less likely to receive adjuvant therapy (OR 0.5, 95% CI 0.3-0.7, p<0.001). The interaction of complications and failure to receive adjuvant therapy significantly increased the hazard of death compared with patients who had neither complications nor adjuvant therapy (HR 2.3, 95% CI 1.6-3.2, p<0.001). Postoperative complications adversely affect long-term outcomes after gastrectomy for gastric cancer. Not receiving adjuvant therapy in the face of POC portends an especially poor prognosis following gastrectomy for gastric cancer.

Evaluation of the effects of neoadjuvant therapy on stage specific outcome estimates in patients with completely resected gastric cancer.

139 Background: The current AJCC staging system for gastric cancer is based on pathologic staging and fails to take into consideration the effects of neoadjuvant therapy. We hypothesize that patients receiving neoadjuvant therapy have a worse outcome than patients with identical pathologic stage not receiving neoadjuvant therapy. Methods: We queried a prospectively maintained gastric cancer database for patients undergoing potentially curative resection for gastric adenocarcinoma between 1985 and 2012. Disease-specific survival (DSS) was estimated by Kaplan-Meier methods. The relationship between DSS and previously identified clinical risk factors was evaluated using Cox regression method. Results: A total of 2,752 patients were identified; of these 904 received neoadjuvant therapy and 1,848 received no neoadjuvant therapy. Patients receiving neoadjuvant therapy were younger (60.7 vs. 65.7 years) and more often male (72.9% vs. 62.4%). Their tumors were more often at the GE junction, but histology, differentiation, and rates of perineural and vascular invasion were similar. Of the 904 patients that received neoadjuvant treatment, 108 (11.9%) had a complete pathologic response. At a median follow up of 4.5 years, 5-year DSS is significantly worse for stage I patients (77% vs. 92%, p &lt; 0.001) and stage III patients (18% vs. 28%, p = 0.025) receiving neoadjuvant therapy; there is a trend towards worse survival for stage II patients (60% vs. 67%, p = 0.059). Factors associated with inferior DSS include age, male sex, diffuse or mixed histology, tumor site, depth of invasion, tumor size, number of positive and negative lymph nodes, and neoadjuvant treatment. The effect of neoadjuvant treatment remains significantly associated with DSS (HR 1.30 [95%CI: 1.12-1.50], p = 0.0004) after adjusting for these other known risk factors. Conclusions: Patients receiving neoadjuvant therapy have a worse stage-specific survival compared to patients not receiving neoadjuvant treatment. The AJCC staging system should be updated to reflect this difference in survival in order to appropriately prognosticate based on pathologic staging.

Factors Associated With Recurrence and Survival in Lymph Node-negative Gastric Adenocarcinoma: A 7-Institution Study of the US Gastric Cancer Collaborative.

To determine pathologic features associated with recurrence and survival in patients with lymph node-negative gastric adenocarcinoma. Multi-institutional retrospective analysis. Lymph node status is among the most important predictors of recurrence after gastrectomy for gastric adenocarcinoma. Pathologic features predictive of recurrence in patients with node-negative disease are less well established. Patients who underwent curative resection for gastric adenocarcinoma between 2000 and 2012 from 7 institutions of the US Gastric Cancer Collaborative were analyzed, excluding 30-day mortalities and stage IV disease. Competing risks regression and multivariate Cox regression were used to determine pathologic features associated with time to recurrence and overall survival. Differences in cumulative incidence of recurrence were assessed using the Gray method (for univariate nonparametric analyses) and the Fine and Gray method (for multivariate analyses) and shown as subhazard ratios (SHRs) and adjusted subhazard ratios (aSHRs), respectively. Of 805 patients who met inclusion criteria, 317 (39%) had node-negative disease, of which 54 (17%) recurred. By 2 and 5 years, 66% and 88% of patients, respectively, experienced recurrence. On multivariate competing risks regression, only T-stage 3 or higher was associated with shorter time to recurrence [aSHR = 2.7; 95% confidence interval (CI), 1.5-5.2]. Multivariate Cox regression showed T-stage 3 or higher [hazard ratio (HR) = 1.8; 95% CI, 1.2-2.8], lymphovascular invasion (HR = 2.2; 95% CI, 1.4-3.4), and signet ring histology (HR = 2.1; 95% CI, 1.2-3.6) to be associated with decreased overall survival. Despite absence of lymph node involvement, patients with T-stage 3 or higher have a significantly shorter time to recurrence. These patients may benefit from more aggressive adjuvant therapy and postoperative surveillance regimens.

A nomogram to predict overall survival and disease-free survival after curative resection of gastric adenocarcinoma.

The American Cancer Society projects there will be over 22,000 new cases, resulting in nearly 11,000 deaths, related to gastric adenocarcinoma in the US in 2014. The aim of the current study was to find clinicopathologic variables associated with disease-free survival (DFS) and overall survival (OS) following curative resection of gastric adenocarcinoma, and create a nomogram for individual risk prediction. A nomogram to predict DFS and OS following surgical resection of gastric adenocarcinoma was constructed using a multi-institutional cohort of patients who underwent surgery for primary gastric adenocarcinoma at seven major institutions in the US between January 2000 and August 2013. Discrimination and calibration of the nomogram were tested by C-statistic, Kaplan-Meier curves, and calibration plots. A total of 719 patients who underwent surgery for primary gastric adenocarcinoma were included in the study. Using the backward selection of clinically relevant variables with Akaike information criteria, age, sex, tumor site, depth of invasion, and lymph node ratio (LNR) were selected as factors predictive of OS, while age, tumor site, depth of invasion, and LNR were incorporated in the prediction of DFS. A nomogram was constructed to predict OS and DFS using these variables. Discrimination and calibration of the nomogram revealed good predictive abilities (C-index, DFS 0.711; OS 0.702). Independent predictors of recurrence and death following surgery for primary gastric adenocarcinoma were used to create a nomogram to predict DFS and OS. The nomogram was able to stratify patients into prognostic groups, and performed well on internal validation.

Stage-Stratified Prognosis of Signet Ring Cell Histology in Patients Undergoing Curative Resection for Gastric Adenocarcinoma

The prognosis of signet ring cell (SRC) gastric adenocarcinoma is regarded as poor, although studies addressing outcomes in relation to non-SRC tumors are conflicting. Our objective was to compare the survival of SRC tumors with stage-matched intestinal-type tumors in a cohort of Western patients. Review of a prospectively maintained database identified 569 patients undergoing curative resection (R0) from 1990 to 2009. Patients were divided into three histologic groups on the basis of the Lauren classification: SRC (n = 210), intestinal well- or moderately differentiated (WMD, n = 242) disease, and intestinal poorly differentiated (PD, n = 117) disease. Patient demographics, clinicopathologic features, and postoperative outcomes were determined. Stage-stratified disease-specific mortality was calculated and multivariate analysis performed. When compared with WMD and PD tumors, SRC tumors were associated with younger age (63 years SRC vs. 71 years WMD and 72 years PD, p < 0.0001) and with female sex (58 % SRC vs. 40 % WMD and 40 % PD, p = 0.0003). Median follow-up was 115 months. Patients with stage Ia SRC lesions had a better 5-year disease-specific mortality compared with stage-matched intestinal-type tumors (0 % SRC vs. 8 % WMD and 24 % PD, p = 0.001). In contrast, SRC patients with stage III disease fared significantly worse (78 % SRC vs. 54 % WMD and 72 % PD, p = 0.001). On multivariate analysis, the risk of death from gastric cancer comparing all three groups was lowest for SRC in stage I and highest for SRC in stage III disease (stage III hazard ratio: SRC 1 vs. 0.47 WMD and 0.85 PD). When compared with intestinal-type tumors, SRC tumors at early stages are not necessarily associated with poor outcomes.

Treatment results of curative gastric resection from a specialist Australian unit: low volume with satisfactory outcomes

The incidence of gastric cancer is decreasing in Australia, yet it remains a common cause of cancer-related mortality. Surgical resection remains the cornerstone of curative treatment. High-volume specialized units have reported superior perioperative and oncological outcomes. The role of D2 lymphadenectomy has been controversial as a result of concerns over increased morbidity. Our aim is to report the perioperative and oncological outcomes of curative gastric resection from a specialist Australian upper GI unit. Data from a prospectively maintained database were reviewed for all patients undergoing curative resection for gastric adenocarcinoma from a single unit during a 12-year period. Perioperative and long-term outcomes were compiled. There were 255 curative gastric resections during 12 years. An R0 resection was performed in 96 % with a perioperative mortality rate of 1.6 %. A D2 dissection was performed in 85 % of cases in the past 6 years, with no increase in perioperative morbidity or mortality detected. The 5-year overall survival was 53 %. Our results demonstrate that both short- and long-term outcomes of surgical resection in gastric cancer patients, comparable to international high-volume centers, can be achieved in an Australian upper GI unit. A D2 lymph node dissection can be performed safely without any increase in perioperative risk in a specialist unit that has the necessary training but also the perioperative support structures to manage these complex patients.

Analysis of the risk factors of recurrence after curative resection for gastric adenocarcinoma

Objective To explore prognostic factors associated with early and late recurrences after surgery for patients with gastric adenocarcinoma.Methods 214 patients who underwent curative resection for gastric adenocarcinoma were divided into 2 groups according to recurrence time:an early recurrence group included 143 patients who died within 2 years after surgery,and a late reeurrence group included 71 patients who died more than 2 years after surgery.Indexes such as age,sex,tumor site,tumor size,tumor pathology classification,Borrmann type,TNM staging,lymph node metastasis,operation type and postoperative adjuvant chemotherapy were compared.Results Single factor analysis showed that the tumor diameter,Borrmann type,TNM staging,lymph node metastasis,operation type,adjuvant chemotherapy were asoceiated with postoperative recurrence( test value were 8.32,16.21,24.90,5.22,17.23 and 3.61,respectively;all P ＜ 0.05 ).Multifactor analysis showed that tumor diameter and TNM staging is recurrent independent factors( relative risk were 5.642 and 6.211,respectively ;all P ＜ 0.05 ).Conclusion Tumor size and TNM staging are the most important factors for predicting the timing of recurrence after curative resection for gastric adenocarcinoma.Clinical practice should pay attention to follow up for patients with tumor diameter≥5cm,TNM Ⅲ-Ⅳ stage,especially within two years. Key words: Stomach neplasms; Recurrence; Risk factors