Recurrence After Curative Resection of Early Gastric Cancer

Youn, Ho Geun; An, Ji Yeong; Choi, Min Gew; Noh, Jae Hyung; Sohn, Tae Sung; Kim, Sung

doi:10.1245/s10434-009-0772-2

Cited by 106 publications

(81 citation statements)

References 17 publications

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“…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].…”

Section: Discussionmentioning

confidence: 74%

“…Although the prognosis of stage I GC is known to be excellent in general after curative surgery and we also observed an RFS rate of approximately 90 % at 5 years in our series, postoperative recurrences and/or deaths still occur in a certain percentage of patients with various relapse rates [15,[17][18][19]. With more detection of stage I GC in Korea and Japan, the absolute number of patients with stage I GC who experience recurrence is also increasing, which may result in a large health problem in those countries.…”

Section: Discussionmentioning

confidence: 91%

“…However, there is recurrence in a small but definite number of patients even with stage I GC after curative resection. The recurrence rates for stage I GC after gastrectomy have been reported to range from 1.4 to 13.8 % [15,[17][18][19]. Although several previous studies attempted to evaluate the risk factors for recurrence of or death from early-stage GC, there has been no common prognostic model established based on significant factors for stage I GC because of its relatively low incidence of recurrence or death.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2015

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Background The therapeutic benefit of adjuvant chemotherapy has not been proven in stage I gastric cancer (GC). The aim of this study was to identify stage I GC patients at high risk of recurrence or death. Results With a median follow-up of 54 months (range 0-60 months), 212 patients (7.6 %) experienced recurrence or death, and the 5 -year recurrence-free survival (RFS) rate and overall survival rate were 89.9 and 93.4 %, respectively. With a multivariate analysis, six factors (age over 65 years, male gender, stage IB GC, lymphovascular invasion, perineural invasion, and elevated level of carcinoembryonic antigen) were independent poor prognostic factors for RFS (p \ 0.05). Patients with more than two of six poor risk factors had a 5-year RFS rate of 79 %, whereas patients with fewer risk factors had a 5-year RFS rate of 97 % (p \0.001). Conclusions In this study cohort, we identified six independent risk factors for RFS. The patients with more than two risk factors are expected to have significant risk of recurrence or death after curative resection and should be considered as candidates for adjuvant treatment.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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

et al. 2015

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“…As indicated by long-term follow-up, recurrence and second primary cancers occurred in 6.8 and 2.8% of the patients with EGC, respectively, slightly higher than that in Japan and Korea, and lower compared to Western countries (7)(8)(9)(10)(11)18,19). Moreover, most recurrence occurred within 10 years after the original surgical treatment (86.4%, 19/22).…”

Section: For Hr ---------------------------------------mentioning

confidence: 89%

Long-term survival results and prognostic factors of early gastric cancer

Huang

Wang

Xing

et al. 2011

Experimental and Therapeutic Medicine

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Abstract. In spite of the favorable prognosis of early gastric cancer (EGC), recurrence or second primary cancers present in certain patients after curative surgery. It is crucial to identify who are at high risk and when. In the present study, 323 patients with EGC who underwent curative surgery were studied. A total of 22 patients (6.8%) died of recurrence, 9 patients (2.8%) died of a second primary cancer and 65 patients (20.1%) died of comorbid diseases during the 0.3-33 years of follow-up. Among the 22 patients with recurrence, hematogenous metastases were noted in over half of the cases (77.3%, 17/22); of these cases 15 patients had a recurrence within the first decade after surgery. Histological differentiation and nodal status were correlated with recurrence. Among the second primary cancers, remnant gastric, liver, lung and colon were the most common sites, and the second primary cancers primarily occurred in the second decade after surgery (6/9). Multivariate analysis identified nodal status (HR=4.20), vessel involvement (HR=3.40) and histological differentiation (HR=3.52) as independent prognostic factors for disease-free survival. However, gender, age and differentiation were independent influencing factors for overall survival. Comorbid diseases, recurrence and second primary cancers are the main cause of death in EGC patients after curative resection. Thus, treatment of comorbid diseases and a periodic follow-up schedule may contribute to improved prognosis. IntroductionEarly gastric cancer (EGC) is defined as gastric carcinoma confined to the mucosa and/or submucosa irrespective of lymph node involvement and tumor size, according to the Japanese Classification of Gastric Carcinoma (JCGC) (1). Compared to advanced gastric cancer (AGC), EGC has a more favorable prognosis after curative resection; the 5-year survival rate is higher than 90% in Japan (2), Korea (3), and slightly lower in Italy, France and the US (4-6). In spite of the very favorable prognosis of EGC, recurrence or second primary cancers present in certain patients after curative surgery, with the recurrence or second primary cancer rate varying from 1.4 to 13.7% (5,7-11). It is crucial to understand the prognostic factors and features of recurrence in patients with EGC and to identify who are at high risk and when; a subsequent follow-up schedule or adjuvant therapy may be considered accordingly.The incidence of EGC is approximately 10% among in-patients with gastric carcinoma in China. However, due to the relatively low incidence of recurrence and favorable prognosis after curative resection for EGC, relevant studies have been limited. Furthermore, most previous reports have focused on short-term survival results and few have investigated survival over 10 years (4,5,7,(9)(10)(11). In the present study, we assessed the long-term survival profiles of patients with EGC at our single institute through 0.3-33 years of follow-up. Survival rate, characteristics of recurrence and causes of death were analyzed, and prognostic factors were als...

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“…Although the outcome of patients with EGC following curative surgery is excellent, cancer recurrence is a rare event and could occur even after curative gastrectomy with an incidence of 1.4-2.7% (2)(3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Metachronous liver and bone metastasis from small early gastric carcinoma without lymph node involvement: A case report

Namikawa

Shiga

Ichikawa

et al. 2012

Molecular and Clinical Oncology

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Abstract.A 65-year-old man was referred to our Hospital for examination of gastric cancer initially diagnosed by medical check-up. Esophagogastroduodenoscopy demonstrated a superficial depressed-type gastric cancer in the antrum, and abdominal computed tomography showed no evidence of distant metastases. A tumor measuring 11 mm in diameter was removed by endoscopic submucosal dissection (ESD). Since histological examinations of ESD specimens showed a well-differentiated adenocarcinoma invading the submucosal layer with lymphatic invasion, the patient subsequently underwent laparoscopy-assisted distal gastrectomy with regional lymph node dissection, resulting in no residual carcinoma and no lymph node metastasis. The patient developed solitary liver metastasis one year later and was treated with trastuzumab plus capecitabine/cisplatin since results of the immunohistochemical analysis of the resected specimens demonstrated overexpression of the human epidermal growth factor receptor 2 (HER2). The patient was alive 12 months after surgical resection of the liver metastasis and subsequently developed bone metastasis. Controversy remains over the role of HER2 status as a prognostic factor in gastric cancer. However, it has been generally reported that HER2 overexpression correlates with aggressive biological behavior and poor prognosis. HER2 overexpression is a potentially useful predictive factor for tumor recurrence and poor prognosis even in early gastric cancer cases. IntroductionEarly gastric cancer (EGC) is defined as the presence of a lesion confined to the mucosa or submucosa, regardless of the presence of regional lymph node metastasis, and has a good prognosis with appropriate treatment (1). Although the outcome of patients with EGC following curative surgery is excellent, cancer recurrence is a rare event and could occur even after curative gastrectomy with an incidence of 1.4-2.7% (2-5).Endoscopic resection with endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) is widely accepted as the standard treatment for EGC without lymph node metastasis and enables a clinician to resect a target lesion en bloc (6,7). Most EGC confined to the mucosa can be curatively treated by endoscopic resection, since lymph node metastasis is rare in such cases. Endoscopic resection is currently considered appropriate for the treatment of intestinaltype gastric cancer cases without central ulceration that are <2 cm in diameter, according to guidelines for EMR/ESD established by the Japanese Gastric Cancer Association (7). However, gastrectomy with lymph node dissection should be performed in patients with submucosal invasion with or without margin involvement following endoscopic resection (8,9).In this study, a case of metachronous liver and bone metastasis after laparoscopy-assisted distal gastrectomy is described, following initial treatment by ESD for small EGC without lymph node metastasis, showing human epidermal growth factor receptor 2 (HER2) overexpression. All diagnostic procedures and therapy...

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Recurrence After Curative Resection of Early Gastric Cancer

Cited by 106 publications

References 17 publications

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

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

Long-term survival results and prognostic factors of early gastric cancer

Metachronous liver and bone metastasis from small early gastric carcinoma without lymph node involvement: A case report

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