Clinicopathological analysis for recurrence of stage Ib gastric cancer (according to the second English edition of the Japanese classification of gastric carcinoma)

Abstract

Background The prognosis for patients with stage Ib (second English edition of the Japanese classification of gastric carcinoma) gastric cancer is promising, with an expected 5-year survival of 90%. Despite this relatively high survival rate, the outcome for patients who experience recurrence is poor. To date, however, prognostic and recurrence factors for stage Ib gastric cancer are poorly understood, and appropriate adjuvant chemotherapy protocols have not been developed. Methods We retrospectively analyzed data from 86 stage Ib gastric cancer patients who underwent curative gastrectomy to determine the rates and predictive factors of recurrence. Results Eleven patients showed recurrence, with a 12.8% 5-year cumulative recurrence rate. Nearly all of these patients were initially histologically diagnosed with poorly differentiated adenocarcinoma. Based on univariate analyses, recurrence was associated with gender and histological type. Multivariate analyses revealed that the only independent risk factor for recurrence was histologically undifferentiated-type adenocarcinoma. The 5-year survival rate of patients with undifferentiated-type adenocarcinoma was 84%. The predominant recurrence pattern was peritoneal dissemination, and was typically observed 1-3 years post-resection. ConclusionThis retrospective study identified undifferentiated-type adenocarcinoma as the only risk factor for recurrence in stage Ib gastric cancer patients. Although randomized controlled studies are necessary, stage Ib gastric cancer patients with this identified recurrence risk factor would be candidates for adjuvant chemotherapy.

The pattern and risk factors of recurrence of proximal gastric cancer after curative resection

“…Consistently, the 85.9% proximal patients in our study recurred in 2 years 8, 10. Loco‐regional recurrence, hematogenous metastases and peritoneal recurrence were the most common pattern of recurrence 21. The depth of invasion, negative lymph node counts and mode of surgery were associated with the recurrence pattern.…”

Risk factors for selection of patients at high risk of recurrence or death after complete surgical resection in stage I gastric cancer

“…Although the overall stage is determined by a combination of T and N stage, our findings may suggest that the overall stage may independently affect the prognosis beyond each of T stage and N stage. Of the six independent variables we observed, one or more were repeatedly observed as risk factors for recurrence in each of the previous studies with a smaller patient population with early-stage GC [12,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. In general, metastasis to lymph nodes has been reported to be one of the most significant risk factors for recurrence of early-stage GC [17,29].…”

“…The depth of invasion is generally related to metastasis to lymph nodes [18,29]; lymphatic or vascular invasion, submucosal invasion, and old age are other risk factors for metastasis to lymph nodes. In a few studies including only stage IB GC, undifferentiated adenocarcinoma, tumor size greater than 3 cm, and the presence of perineural invasion were also observed as poor prognostic factors [26,28]. Notably, distinct from previous studies, we included serum levels of tumor markers as relevant clinicopathologic factors, and multivariate analysis revealed CEA as an independent predictor for RFS.…”

Prognostic impact of venous invasion in stage IB node-negative gastric cancer

“…Undifferentiated-type adenocarcinoma has been reported to be the only risk factor for recurrence in patients with stage IB gastric cancer [7]. However, this finding was based on studies including patients who had T1 (early) gastric cancer with regional lymph node metastasis, and little is known about the risk factors for recurrence in stage IB advanced (T2 or T3) gastric cancer without lymph node metastasis.…”