Analysis Of Recurrence,metastasis And Prognostic Factors Of Gastric Cancer After Radical Resection Of D2 And Radiotherapy And Chemotherapy

Purpose:To investigate the recurrence and metastasis of gastric cancer patients after radical gastrectomy with D2 and the related clinical factors affecting the disease-free survival time.Method:A retrospective analysis was made on 55 patients with first recurrence and metastasis of gastric cancer after D2 radical operation in our hospital from June 2013 to December 2016.The location of first recurrence and metastasis and prognostic factors were analyzed.Data were recorded by EXCEL table,and SPSS22 software was used for statistical analysis.The basic information of patients and the prognostic factors related to DFS were summarized,including T stage,N stage,age,number of chemotherapy cycles,gender,primary site of tumors,Lauren’s classification,radiotherapy methods,etc.The survival rate between groups was calculated by Kaplan-Meier and Log-rank test and single factor was used.Meaningful single factors were further analyzed by COX model and multiple factors were analyzed by Chi-square test or Fisher’s exact probability method.T-stage,N-stage and the correlation between primary site and recurrence patterns were analyzed by Chi-square test method.The difference was statistically significant(P<0.05).The percentage constituent ratio was used for the relationship between recurrence patterns and time distribution of recurrence and metastasis.The distribution of recurrence and metastasis time is year by year.Result:1.The median overall survival time and disease-free survival time after radical surgery for gastric cancer D2 were 24 months and 17 months,respectively.The median disease-free survival time was 11 months in patients with local recurrence,18 months in patients with peritoneal implantation,14 months in patients with distant metastasis and 12 months in patients with multiple recurrence patterns.2.The recurrence rate of gastric cancer after radical resection of D2 was the highest(38%)within 0-12 months,followed by 13-24 months(33%)and more than 25 months(29%).Local recurrence occurred in 0-12 months(50%),peritoneal implantation in 13-24 months(43%)and distant metastasis in 0-12 months(39%).3.Univariate analysis showed that age,T stage,N stage and chemotherapy cycle were the influencing factors of disease-free survival of patients with gastric cancer after radical operation of D2.4.Multivariate analysis showed that the number of chemotherapy cycles,T stage and N stage were independent factors affecting the disease-free survival of patients after radical D2 gastrectomy.5.The main recurrence patterns of gastric cancer after radical operation of D2 are distant metastasis and peritoneal implantation.The most common organ of distant metastasis is liver.Postoperative adjuvant radiotherapy and chemotherapy can reduce the local recurrence rate of gastric cancer.6.The recurrence pattern of gastric cancer after radical operation of D2 is correlated with the location and N stage of the primary tumor.The recurrence rate of peritoneal implantation in patients with gastric antrum is higher.The recurrence rate of peritoneal implantation in patients with N1 and N2 stage is mainly.Conclusion:Adjuvant chemoradiotherapy after radical resection of gastric cancer D2 can significantly reduce the probability of local recurrence.After D2 radical resection of gastric cancer,the recurrence and metastasis after adjuvant chemoradiotherapy are mainly distant metastasis and peritoneal implantation.For patients with gastric cancer whose N stage was N1N2 and the primary tumor lesion was located in the gastric antrum,peritoneal implantation recurrence is predominant.Postoperative adjuvant intraperitoneal hyperthermic perfusion chemotherapy may prevent peritoneal metastasis in patients with gastric cancer.