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

Abstract

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.

Defining the optimal timing of adjuvant therapy for resected pancreatic adenocarcinoma: A statewide cancer registry analysis

“…Several trials have addressed the effect of the recovery period following curative surgery and start of adjuvant therapy as potential contributors to outcome in other cancers including breast , colorectal , and gastric . In breast cancer, there were conflicting reports, with no difference in disease‐free survival or OS in patients who received adjuvant chemotherapy within the arbitrary cut‐off of 21 days after surgery .…”

“…In the context of this study's findings, while "timely" AT should remain the clinical goal after safe recovery for those who undergo upfront pancreatectomy, one should not forego intended AT simply because the initiation date is beyond the theoretical 8-week "window." Several trials have addressed the effect of the recovery period following curative surgery and start of adjuvant therapy as potential contributors to outcome in other cancers including breast [15], colorectal [16], and gastric [17,18]. In breast cancer, there were Journal of Surgical Oncology conflicting reports, with no difference in disease-free survival or OS in patients who received adjuvant chemotherapy within the arbitrary cutoff of 21 days after surgery [19].…”

Characteristics of gastric cancer recurrence five or more years after curative gastrectomy

“…Nonetheless, patients with curative gastrectomy continue to experience recurrence during follow-up. More recent studies have shown that the overall 5-year survival rate of gastric cancer has improved because of curative gastrectomy with chemotherapy (2,3). However, death from gastric cancer is almost entirely caused by recurrent diseases (4).…”

Preoperative globulin‐to‐albumin ratio predicts outcome after curative resection in patients with gastric cancer

“…Previous study reported that submucosal layer invasion, lymph node metastasis, and pathological differentiation (tub1 and tub2) were the risk factors for tumor recurrence after surgery for early stage GC 43. On the other hand, another previous study revealed that high age, male, lymphovascular invasion, stage IB (proper muscle invasion or lymph node metastasis), perineural invasion, and elevated tumor marker were independent poor prognostic factors for RFS 44. Although we did not investigate the relationship between GAR and these clinical characteristics of stage I GC which was associated with tumor recurrence, our result indicated that preoperative high GAR (>0.80) was useful for predicting poor prognosis of RFS in stage I GC patients in comparison with low GAR (<0.80).…”

“…The recurrence rate in patients with early stage GC was reported to be 1.4%‐3.0% 43, 44. Previous study reported that submucosal layer invasion, lymph node metastasis, and pathological differentiation (tub1 and tub2) were the risk factors for tumor recurrence after surgery for early stage GC 43.…”