Analysis Of Clinicopathologic Factors And Prognosis Of Recurrence In Gastric Cancer Following Curative Resection

Background and Objectives:Gastric cancer is the most common malignant tumors in digestive system. Besides it is the fourth most commonly cancer and the second leading cause of cancer-related deaths worldwide. Even after curative resection, recurrences are still common. Death from gastric cancer after curative resection is mostly due to recurrence as well. In this study, we analyzed the clinicopathologic factors of patients with recurrence of gastric cancer after curative resection to study the related factors that influence the gastric cancer recurrence as well as the influence factors related to the prognosis of recurrence.Methods:We retrospectively analyzed the clinical data of266patients with recurrence of gastric cancer after total gastrectomy in the Chinese people’s liberation army general hospital from January,2000to June,2011. We followed up the patients’survival time, compared the clinicopathologic factors of the early recurrence group (≤2years) and late recurrence group (>2years), and determined the risk factors of early recurrence after gastrectomy. Then, we analyzed clinicopathologic factors among locoregional recurrence, peritoneal recurrence and distant recurrence, and then discussed the related clinicopathologic factors from different recurrence groups. Finally, we evaluated the survival time of patients with recurrence of gastric cancer after total gastrectomy, their1st,2nd,3rd-year survival rates, and analyzed the prognostic factors of recurrence.Results:The median survival time of early recurrence group was11months, and the1,2,3-year survival rates were46.5%、21.2%、14.2%. The age(P=0.028), tumor site(P<0.001), tumor size(P=0.024), Borrmann type(P=0.024), lymphadenectomy (P<0.001), T stage(P=0.001), N stage(P<0.001), the number of nodes detected (P<0.001), lymph node metastasis rate(P<0.001), TNM stage(P<0.001), postoperative chemotherapy(P=0.035), operative blood loss(P<0.001) were significantly associated with early recurrence. The age(P=0.003), T stage(P=0.046) and N stage(P=0.001) were independent risk factors that affects the early recurrence after curative gastrectomy, meanwhile lymphadenectomy was an independent protective factor that affects the early recurrence on multivariate analysis.The median survival time of locoregional recurrence group was19months, and the1st,2nd,3rd-year survival rates were59.5%,45.3%,38.4%. The median survival time of distant recurrence group was13months, and the1st,2nd,3rd-year survival rates were54.2%,20.8%,13.2%. The median survival time of peritoneal recurrence group was8months, and the1st,2nd,3rd-year survival rates were32.7%,14.8%,8.2%. The tumor site (P=0.043), lymphadenectomy (P=0.002), T stage (P=0.046), the number of nodes detected (P=0.043), surgical approach(P=0.008), operative blood loss(P=0.004) and recurrence-free interval(P=0.008) were significantly different between the different types of recurrence group. The T stage(<T4/T4)(P=0.027) and operative blood loss(≤200/>200)(P=0.024) were independent risk factors that affect the peritoneal recurrence and distant recurrence.Of all266patients, the average survival time was15.2months, the median survival time was12months, and the lst,2nd,3rd-year survival rates were51.3%,27.6%,20.5%, respectively. Surgery approach(P<0.001), tumor size(P<0.001), histological differentiation(P=0.003), T stage(P<0.001), N staging(P<0.001), positive lymph node metastasis rate(P=0.025), the number of nodes detected (P=0.033), TNM staging(P <0.001), surgical margin(P<0.001), recurrence-free interval(P=0.002), recurrence type (P<0.001), surgery after recurrence(P=0.010), chemotherapy after recurrence(P=0.022), and treatment after recurrence(P<0.001) were the prognostic factors of recurrence of gastric cancer following curative resection. Surgical margin, N staging, TNM staging and recurrence type were the independent risk prognostic factors of recurrence, and recurrence-free interval, treatment after recurrence were the independent protective prognostic factors of recurrence.Conclusion:The prognosis of early recurrence in gastric cancer following curative resection is relatively poor. The age, T stage and N stage are the independent risk factors of early recurrece, and the lymphadenectomy is an independent protective factors of early recurrence in gastric cancer following curative resection. The prognosis of peritoneal reucrrence and distant recurrence is worse than locoregional recurrence. The T stage and operative blood loss are independent risk factors of peritoneal recurrence and distant recurrence. The surgical margin, N stage. TNM stage and type of recurrence are independent risk prognostic factors of recurrence, and the recurrence-free interval and treatment after recurrence are independent protective prognostic factors of recurrence in gastric cancer following curative resection.