PREDICTORS OF PERITONEAL RECURRENCE AFTER CURATIVE GASTRECTOMY FOR GASTRIC ADENOCARCINOMA: A SINGLE INSTITUTION ANALYSIS
Daniel J. Szor*, Marina A. Pereira, Francisco Tustumi, André R. Dias, Marcus F. Ramos, Bruno Zilberstein, Ulysses Ribeiro
Universidade de Sao Paulo Instituto do Cancer do Estado de Sao Paulo, Sao Paulo, São Paulo, Brazil
Gastric cancer is one of the most common solid tumors presenting high morbidity and mortality. Peritoneal recurrence (PR) after curative intended gastrectomy impacts negatively the quality of life due to malignant intestinal obstruction and intractable ascites, leading to poor prognosis. Early detection of PR remains a challenge and there are no reliable predictors of its occurrence in clinical practice. The aim of this study was to identify the risk-factors for PR after curative intended gastrectomy. Methods Patients who underwent curative intention surgery for gastric adenocarcinoma were identified from a prospectively maintained single institution database (November 2010 to December 2021). Risk factors for PR were evaluated using univariate and multivariate analysis. Results: Seven hundred and seven patients (58.7% male – mean age 62.4 years) who underwent curative gastrectomy between 2010 and 2021 were included. 157 patients (22.2%) had disease recurrence after surgery and the peritoneum was the first site in 61 (8.6%) of the cases. Patients with peritoneal recurrence had a female predominance (p=0.041), higher preoperative CA19.9 (p<0.001) and CEA levels (p<0.028), underwent total gastrectomy (p=0.005), had diffuse histological type (p=<0.001) and pT3-4 (p<0.001) tumors. Nodal (p<0.001), lymphatic (p<0.001), venous (p<0.001) and perineural involvement (p<0.001) were all related to PR. A multivariate analysis identified factors associated with PR: total gastrectomy (HR4.17 95%IC 2.01-8.65 p<0.001), diffuse histological type (HR3.51 95%IC 1.51-32.7 p<0.013), pT3-4 (HR7.03 95%IC 1.51-32.7-8.65 p<0.00=13), nodal involvement (HR1.66 95%IC 0.66-4.18 p<0.001) and high preoperative CEA (HR2.42 95%IC 1.18-4.98 p=0.016).
The median disease-free survival for PR and overall survival were 13.5 and 21.4 months, respectively. Patients who had PR in the first 12 months after surgery had a lower overall survival (p<0.001). Conclusions: Peritoneal recurrence after curative intended gastrectomy implies in low survival, especially if diagnosed in the first twelve months after surgery. Total gastrectomy, diffuse histological type, nodal involvement, and high preoperative CEA levels were independent factors associated to peritoneal recurrence.
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