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Rates and Patterns of Recurrence after Curative Intent Resection for Gastric Cancer: A United States Multi-Institutional Analysis

医学 四分位间距 胃切除术 癌症 优势比 入射(几何) 内科学 外科 远处转移 胃肠病学 癌症复发 转移 光学 物理
作者
Gaya Spolverato,Aslam Ejaz,Yuhree Kim,Malcolm H. Squires,George A. Poultsides,Ryan C. Fields,Carl Schmidt,Sharon M. Weber,Konstantinos I. Votanopoulos,Shishir K. Maithel,Timothy M. Pawlik
出处
期刊:Journal of The American College of Surgeons [Lippincott Williams & Wilkins]
卷期号:219 (4): 664-675 被引量:168
标识
DOI:10.1016/j.jamcollsurg.2014.03.062
摘要

BACKGROUND: Reports on recurrence and outcomes of US patients with gastric cancer are scarce. The aim of this study was to determine incidence and pattern of recurrence after curative intent surgery for gastric cancer. STUDY DESIGN: Using the multi-institutional US Gastric Cancer Collaborative database, we identified 817 patients undergoing curative intent resection for gastric cancer between 2000 and 2012. Patterns and rates of recurrence along with associated risk factors were identified using adjusted regression analysis. Recurrences were classified as locoregional, peritoneal, or hematogenous. RESULTS: Median patient age was 65.8 years (interquartile range [IQR] 56.4, 74.7); the majority of patients were male (n = 462, 56.6%) and white (n = 511, 62.5%). At the time of surgery, the majority of patients underwent a partial gastrectomy (n = 481, 59.2%) with a complete R0 resection achieved in 91.6% (n = 748) of patients. At the time of last follow-up, 244 (29.9%) of 817 patients developed a recurrence; 163 (66.8%) patients had recurrence at only a single site; the remaining 81 (33.2%) had multiple sites of initial recurrence. Among patients who recurred at a single site, recurrence was most common at a distant location and included hematogenous (n = 57, 23.4%) or peritoneal (n = 47, 19.3%) only metastasis. Tumors at the gastroesophageal junction (odds ratio [OR] 3.18, 95% CI 1.08 to 9.40; p = 0.04) were associated with higher risk of locoregional recurrence, while the presence of multiple lesions (OR 10.82, 95% CI 3.56 to 32.85; p < 0.001) remained associated with an increased risk of distant hematogenous recurrence after adjusted analysis. Recurrence was associated with worse survival, with a median recurrence-free survival of 10.8 months (IQR 8.9, 12.8) among those who experienced a recurrence. CONCLUSIONS: Nearly one-third of patients experienced recurrence after gastric cancer surgery. The most common site of recurrence was distant.
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