Differences in risk factors between patterns of recurrence in patients after curative resection for advanced gastric carcinoma

Abstract

BackgroundRecurrence patterns in patients who have undergone curative gastrectomy for advanced gastric carcinoma can be classified as peritoneal, hematogenous, or lymphatic. The aim of this study was to clarify differences in risk factors between these different types of recurrence pattern.MethodsPostoperative courses, including sites of recurrence and periods between surgery and recurrence, of patients who had undergone curative gastrectomy for advanced gastric carcinoma (more than pT2 invasion) were surveyed in detail. Clinicopathological factors were examined as potential independent risk factors for each recurrence pattern, based on recurrence-free survival, using multivariate analysis.ResultsMultivariate analysis identified depth of tumor invasion (pT4 vs. pT2/3; hazard ratio (HR), 7.05; P < 0.001), number of lymph node metastases (pN2/3 vs. pN0/1; HR, 4.02; P = 0.001), and histological differentiation (G3/4 vs. G1/2; HR, 2.22; P = 0.041) as independent risk factors for peritoneal metastasis. The number of lymph node metastases (HR, 26.21; P < 0.001) and venous vessel invasion (HR, 5.09; P = 0.001) were identified as independent risk factors for hematogenous metastasis. The number of lymph node metastases (HR, 6.00; P = 0.007) and depth of tumor invasion (HR, 4.70; P = 0.023) were identified as independent risk factors for lymphatic metastasis.ConclusionsThis study clarified differences in risk factors between various patterns of recurrence. Careful examination of risk factors could help prevent oversight of recurrences and improve detection of recurrences during follow-up. The number of lymph node metastases represents an independent risk factor for all three patterns of recurrence; thus, patients with multiple lymph node metastases warrant particular attention.

The patterns and timing of recurrence after curative resection for gastric cancer in China

“…3d, p  < 0.001). Several studies had noted that postoperative recurrence associated with factors, such as T stage, extent of lymph node invasion, and tumor location [3, 7, 10–12, 17, 19, 22–26], which were consistent with this study. Based on this database, female and signet ring cell cancer contributed to increased incidence of peritoneum implanting, which reported in previous results [17, 27].…”

“…Based on this database, female and signet ring cell cancer contributed to increased incidence of peritoneum implanting, which reported in previous results [17, 27]. However, we did not find that lymph node invasion related to peritoneum implanting [22]. The age of patients closely associated with distant metastasis and peritoneum implanting.…”

Role of c-Src activity in the regulation of gastric cancer cell migration

“…Upregulation of MT1-MMP can effectively elevate invasiveness in human cancer cells, including gastric cancer (24–26). However, to be active, the zymogens of MT1-MMP or VEGF must be cleaved from the propeptides by the protein convertase furin (7,9,27).…”

Relationship Between 18F-FDG Uptake on PET and Recurrence Patterns After Curative Surgical Resection in Patients with Advanced Gastric Cancer

“…Although previous studies showed no difference in prognosis between peritoneal recurrence and distant metastasis (8,25,26), the evaluation of risk factors for peritoneal recurrence and distant metastasis could improve selection of treatment and follow-up strategies. Depth of tumor invasion, lymph node metastasis, tumor size, Lauren classification diffuse type, undifferentiated cancer, and Bormann classification type 4 are independent risk factors for peritoneal recurrence (5,7,8,25,27,28). Meanwhile, depth of tumor invasion, lymph node metastasis, venous invasion, and Lauren classification intestinal type were determined to be independent risk factors for distant metastasis (5,8,25,28).…”

“…Depth of tumor invasion, lymph node metastasis, tumor size, Lauren classification diffuse type, undifferentiated cancer, and Bormann classification type 4 are independent risk factors for peritoneal recurrence (5,7,8,25,27,28). Meanwhile, depth of tumor invasion, lymph node metastasis, venous invasion, and Lauren classification intestinal type were determined to be independent risk factors for distant metastasis (5,8,25,28). Similar to the previous studies, we also found that pT stage, lymph node metastasis, Bormann type 4, and Lauren classification nonintestinal type were independent risk factors for peritoneal recurrence, whereas lymphovascular invasion was an independent risk factor for distant metastasis.…”