|
Back to 2016 Annual Meeting
Patterns of Initial Recurrence After Curative Resection for Gastric Adenocarcinoma According to Lauren Histologic Type
Jun Ho Lee1,2, Kevin Chang*2, Changhwan Yoon2, vivian strong2, Daniel Coit2, Sam Yoon2
1Surgery, Sungkyunkwan University, Samsung Medical Center, Seoul, Korea (the Republic of); 2Surgery, Memorial Sloan-Kttering Cancer Center, New York, NY
Objective: The aim of this study was to review recurrence patterns after resection for gastric adenocarcinoma (GA) according to Lauren histologic type.
Methods: A retrospective review of a prospectively maintained gastric cancer database was performed. Clinicopathologic factors, patterns of recurrence, recurrence-free survival (RFS), and overall survival (OS) were examined according to Lauren histologic type.
Results: From January 2000 to June 2010, 1107 patients underwent potentially curative resection for gastric adenocarcinoma. Of these, 435 (39%) had recurrence and complete data on recurrence could be obtained in 386 patients (91%). There was a significant difference in patterns of recurrence in the 206 intestinal and 180 diffuse/mixed tumors. Distant metastasis was the most common recurrence site in patients with intestinal tumors (54%) followed by locoregional (20%) and peritoneal (15%). Recurrence was multifocal in 11%. For diffuse/mixed type tumors, peritoneal recurrence the most common (37%) followed by distant (32%), locoregional (22%), and multifocal (9%). On multivariate analysis, diffuse/mixed tumor was associated with peritoneal recurrence (HR 2.33, CI 1.37-3.96) along with more advanced T stage (HR 2.30, CI 1.15-4.60). There was no difference in OS or RFS in patients with intestinal vs. diffuse/mixed type tumors. However, median OS after recurrence was significantly better for patients with intestinal tumors (10.0 vs. 7.2 months, p=0.002).
Conclusion: Patterns of recurrence after resection and the survival after recurrence for patients with GA vary based on Lauren histologic type. These results may be helpful in choosing adjuvant treatment and surveillance options.
TABLE 1. Comparison of Clinicopathologic Factors according to the Lauren Classification
| | All
(N=386) | Intestinal
(N=206) | Diffuse/Mixed
(N=180) | P value | Age
Mean±S.D., year |
64.0±11.9 |
65.0±12.2 |
62.9±11.3 | 0.078 | Gender
Male
Female |
267 (69.3)
119 (30.8) |
158 (76.7)
48 (23.3) |
109 (60.6)
71 (39.4) | 0.001 | Location
Lower 1/3
Mid 1/3
Upper 1/3
GE junction*
Whole |
77 (19.9)
72 (18.7)
63 (16.3)
167 (43.3)
7 (1.8) |
35 (17.0)
24 (11.7)
26 (12.6)
121 (58.7)
0 |
42 (23.3)
48 (26.7)
37 (20.6)
46 (25.6)
7 (3.9) | <0.001 | Preoperative T stage†
T1
T2
T3
T4 |
49 (12.7)
71 (18.4)
239 (61.9)
4 (1.0) |
24 (12.8)
37 (19.7)
125 (66.5)
2 (1.1) |
25 (14.3)
34 (19.4)
114 (65.1)
2 (1.1) | 0.979 | Pathologic T stage
T1
T2
T3
T4 |
55 (14.3)
49 (12.7)
151 (39.1)
131 (33.9) |
36 (17.5)
34 (16.5)
95 (46.1)
41 (19.9) |
19 (10.6)
15 (8.3)
56 (31.1)
90 (50.0) | <0.001 | N stage
N0
N1
N2
N3 | 123 (31.9)
80 (20.7)
74 (19.2)
109 (28.2) |
78 (37.9)
54 (26.2)
41 (19.9)
33 (16.0) |
45 (25.0)
26 (14.4)
33 (18.3)
76 (42.2) | <0.001 | Pathologic Stage
I
II
III |
62 (16.1)
99 (25.6)
225 (58.3) |
44 (21.4)
59 (28.6)
103 (50.0) |
18 (10.0)
40 (22.2)
122 (67.8) | 0.001 | Operation
Distal subtotal
Total
Esophagectomy ‡ |
107 (27.7)
104 (26.9)
175 (45.4) |
49 (23.8)
36 (17.5)
121 (58.7) |
58 (32.2)
68 (37.8)
54 (30.0) | <0.001 | Perioperative Treatment
None
Preoperative
Postoperative |
124 (32.1)
196 (50.8)
66 (17.1) |
66 (32.0)
113 (54.9)
27 (13.1) |
58 (32.2)
83 (46.1)
39 (21.7) | 0.062 |
Significant factors in bold. * Gastroesophageal junction. * Preoperative T stage of 23 patients was unknown. * Esophagectomy with proximal or total gastrectomy TABLE 2. Multivariate Analysis of Clinicopathologic Factors Potentially Associated With the Presence of Recurrence | | Locoregional
Odds Ratio
(C.I.) | Peritoneal
Odds Ratio
(C.I.) | Distant
Odds Ratio
(C.I.) | Multiple
Odds Ratio
(C.I.) | Gender
Male
Female | - | 1
2.209
(1.306-3.736) | 1
0.605
(0.375-0.976) | - | Location
Distal
Proximal | - | 1
0.725
(0.312-1.688) | - | 1
3.363
(0.699-16.171) | Lauren classification
Intestinal
Diffuse or Mixed | - | 1
2.330
(1.371-3.959) | 1
0.484
(0.312-0.752) | - | Pathologic T stage*
T1-2
T3-4 | - | 1
2.298
(1.148-4.597) | 1
0.653
(0.402-1.062) | 1
1.720
(0.737-4.017) | N stage
N0
N1-3 | 1
0.533
(0.322-0.883) | - | - | - | Types of Gastrectomy
Distal
Proximal or Total
Esophagectomy† | - | - | - | 1
1.170
(0.205-6.678)
1.305
(0.194-8.785) | Perioperative Treatment
None
Preoperative
Postoperative | - | 1
1.026
(0.469-2.241)
0.494
(0.176-1.385) | 1
0.684
(0.379-1.235)
1.115
(0.664-1.871) | - |
Back to 2016 Annual Meeting
|
