Recurrence following curative resection for gastric carcinoma

TLDR

Recurrent gastric cancer is difficult to diagnose and treat, and outcomes remain poor, highlighting the need for perioperative adjuvant therapies. The study aimed to identify risk factors for recurrence and prognosis in patients who underwent curative resection for gastric cancer. The authors performed univariate and multivariate analyses on 508 patients with confirmed recurrence to identify factors influencing recurrence patterns and timing, noting a mean recurrence time of 21.8 months with peritoneal recurrence most common. Risk factors for recurrence included serosal invasion and lymph node metastasis for all patterns and early recurrence, with additional pattern‑specific factors such as younger age and diffuse type for peritoneal recurrence, older age and larger tumour for haematogenous recurrence, and older age, larger tumour, diffuse type, proximal location, and subtotal gastrectomy for locoregional recurrence; early recurrence was also linked to diffuse type and total gastrectomy, and only 19 patients could be cured by reoperation, with median survival after conservative or palliative treatment under 12 months.

Abstract

The diagnosis and treatment of recurrent gastric cancer remains difficult. The aim of this study was to determine the risk factors for recurrence of gastric cancer and the prognosis for these patients.Of 2328 patients who underwent curative resection for gastric cancer from 1987 to 1995, 508 whose recurrence was confirmed by clinical examination or reoperation were studied retrospectively. The risk factors that determined the recurrence patterns and timing were investigated by univariate and multivariate analysis.The mean time to recurrence was 21.8 months and peritoneal recurrence was the most frequent (45.9 per cent). Logistic regression analysis showed that serosal invasion and lymph node metastasis were risk factors for all recurrence patterns and early recurrence (at 24 months or less). In addition, independent risk factors involved in each recurrence pattern included younger age, infiltrative or diffuse type, undifferentiated tumour and total gastrectomy for peritoneal recurrence; older age and larger tumour size for disseminated, haematogenous recurrence; and older age, larger tumour size, infiltrative or diffuse type, proximally located tumour and subtotal gastrectomy for locoregional recurrence. Other risk factors for early recurrence were infiltrative or diffuse type and total gastrectomy. Reoperation for cure was possible in only 19 patients and the mean survival time after conservative treatment or palliative operation was less than 12 months.The risk factors for each recurrence pattern and timing of gastric cancer can be predicted by the clinicopathological features of the primary tumour. Since the results of treatment remain dismal, studies of perioperative adjuvant therapy in an attempt to reduce recurrence are warranted.