Gaya Spolverato1, Aslam Ejaz1, Yuhree Kim1, Malcolm H Squires2, George A Poultsides3, Ryan C Fields4, Carl Schmidt5, Sharon M Weber6, Konstantinos Votanopoulos7, Shishir K Maithel2, Timothy M Pawlik8. 1. Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD. 2. Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA. 3. Department of Surgery, Stanford University, Palo Alto, CA. 4. Department of Surgery, Washington University, St Louis, MO. 5. Department of Surgery, The Ohio State University, Columbus, OH. 6. Department of Surgery, Division of Surgical Oncology, University of Wisconsin, Madison, WI. 7. Department of Surgery, Wake Forest University, Winston-Salem, NC. 8. Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: tpawlik1@jhmi.edu.
Abstract
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.
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.
Authors: Leila Sisic; Moritz J Strowitzki; Susanne Blank; Henrik Nienhueser; Sara Dorr; Georg Martin Haag; Dirk Jäger; Katja Ott; Markus W Büchler; Alexis Ulrich; Thomas Schmidt Journal: Gastric Cancer Date: 2017-07-24 Impact factor: 7.370
Authors: Yuhree Kim; Malcolm H Squires; George A Poultsides; Ryan C Fields; Sharon M Weber; Konstantinos I Votanopoulos; David A Kooby; David J Worhunsky; Linda X Jin; William G Hawkins; Alexandra W Acher; Clifford S Cho; Neil Saunders; Edward A Levine; Carl R Schmidt; Shishir K Maithel; Timothy M Pawlik Journal: Surgery Date: 2017-05-31 Impact factor: 3.982
Authors: Paolo Aurello; Niccolo' Petrucciani; Diego Giulitti; Laura Campanella; Francesco D'Angelo; Giovanni Ramacciato Journal: Med Oncol Date: 2015-12-26 Impact factor: 3.064
Authors: Aaron U Blackham; Doug S Swords; Edward A Levine; Nora F Fino; Malcolm H Squires; George Poultsides; Ryan C Fields; Mark Bloomston; Sharon M Weber; Timothy M Pawlik; Linda X Jin; Gaya Spolverato; Carl Schmidt; David Worhunsky; Clifford S Cho; Shishir K Maithel; Konstantinos I Votanopoulos Journal: Ann Surg Oncol Date: 2015-11-03 Impact factor: 5.344