Recurrence Patterns And Prognosis Analysis For Patients With Locally Advanced Gastric Cancer After Curative Gastrectomy

Purpose The aim of this study is figure out factors affecting recurrence and survivalprognosis of local advanced gastric cancer patients following curative gastrectomy(>D1lymphadenectomy) through retrospectively analyzing their clinicopathologiccharacteristics and first relapse sites.Method We retrospectively analyzed the clinical data of239patients diagnosedwith local advanced gastric cancer following curative gastrectomy(>D1lymphadenectomy)from July2009to July2011at the Second Affiliated Hospital of Soochow University.Recurrence and survival status as well as first relapse site were collected. TheKaplan-Meier method and log-rank test were used for univariate comparisons of survivaland recurrence. Multivariate analysis was done by the COX regression model．Result The median follow-up time was26.6months and the1,2,3year survivalrates were91.2%,77.7%,53.6%with the median survival time of37.7months.67patientsoccurred recurrence among239patients with the recurrence rate of28.0%. There were24local recurrence cases(35.8%),17peritoneal metastasis cases(25.3%),16distant metastasiscases(23.9%) and10multi-regional recurrence cases(17.9%). The age, differentiation,tumor location, size, positive lymph node, T stage, N stage and TNM stage weresignificantly correlated with recurrence, and size(p=0.007), positive lymph node(p<0.001),TNM stage(p=0.001) were independent predictors of recurrence following curativegastrectomy.The age, differentiation, tumor location, size, margin, Borrmann classification,lymphovescular invasion, perineural invasion, positive lymph node, T stage, N stage,pathological TNM stage and adjuvant chemotherapy were significantly associated withsurvival, and differentiation(p=0.017), lymphovescular invasion(p=0.015), Tstage(p=0.001), N stage(p<0.001), and adjuvant chemotherapy(p<0.001) were independentpredictive factors. Meanwhile adjuvant chemotherapy was an independent protective factorthat affects survival on multivariate analysis. Conclusion Recurrence of local advanced gastric cancer is still on a high level withpoor survival even though R0resection and>D1lymphadenectomy carried out．Patientswith big tumor size, positive lymph nodes and advanced TNM staging are more likely torecur. Locoregional recurrence appears the main pattern so that adjuvant radiotherapy issupposed to be applied due to its local treatment target. The role adjuvant radiotherapyplays in improving survival and local control needs more large prospective researches toconfirm.