Randomized clinical trials in gastric cancer

Rates and patterns of recurrence after curative intent resection for gastric cancer: a United States multi-institutional analysis

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.

Investigation of the recurrence patterns of gastric cancer following a curative resection

PURPOSE

The goal of this study was to investigate the recurrence patterns of gastric cancer and determine the predictive information of recurrence patterns of gastric cancer following a curative resection.

METHODS

This study retrospectively analyzed the data of 308 gastric cancer patients who underwent a curative resection, to identify the factors associated with the recurrence patterns.

RESULTS

One hundred and sixty-nine gastric cancer patients had recurrence following curative resection. One hundred and twenty-six patients were observed for 3 years after the operation. Locoregional recurrence formed part of the recurrence pattern in 107 patients, peritoneal dissemination was observed in 98 patients, and distant metastasis occurred in 22 patients. A multivariate analysis revealed that locoregional recurrence was only associated with the Lauren classification (P = 0.003); peritoneal dissemination was only associated with N stage (P < 0.001); and distant metastasis was only associated with the Lauren classification (P = 0.016).

CONCLUSIONS

Locoregional recurrence, peritoneal dissemination, and distant metastasis were the most common recurrence patterns of gastric cancer following a curative resection. Each recurrence pattern is associated with specific clinicopathological factors.

Randomized clinical trials in gastric cancer

Minimally invasive resection has emerged as a surgical technique for gastric cancer, and there has been continued investigation to determine the appropriate extent of lymphadenectomy in gastric cancer patients. There has also been significant progress in evaluating the role of chemotherapeutic regimens used in the neoadjuvant and adjuvant settings for patients with resectable disease. We also summarize a selection of RCT trials focused on the perioperative care of the gastric cancer patient.

Patterns of initial recurrence in completely resected gastric adenocarcinoma

OBJECTIVE

To review recurrence patterns in completely resected gastric adenocarcinoma.

SUMMARY BACKGROUND DATA

Despite improvements in the surgical treatment of gastric adenocarcinoma, recurrence rates remain high in patients with advanced stage disease. Understanding the timing and patterns of recurrence is essential to develop effective adjuvant treatment strategies.

METHODS

A retrospective review of a prospectively maintained gastric cancer database was carried out. The timing and pattern of recurrence were reviewed. Univariate and multivariate analyses were performed to identify factors predictive of recurrence patterns.

RESULTS

From July 1985 through June 2000, 1172 patients underwent an R0 resection. Of these, 496 (42%) had recurrence and complete data on recurrence could be obtained in 367 patients (74%). Among the documented recurrences, 79% were detected within 2 years of operation. Locoregional sites were involved as any part of the recurrence pattern in 199 patients (54%). Distant sites were involved as any part of the recurrence in 188 patients (51%) and peritoneal recurrence was detected as any part of the recurrence in 108 patients (29%). On multivariate analysis, peritoneal recurrence was associated with female gender, advanced T-stage, and distal and diffuse type tumors; locoregional recurrence was associated with male gender and proximal location; distant recurrence was associated with proximal location, early T stage, and intestinal type tumors. The median time to death from the time of recurrence was 6 months.

CONCLUSIONS

Recurrence after complete resection of gastric adenocarcinoma usually occurs within 2 years and is rapidly fatal. Patterns of recurrence are variable and may be associated with specific clinicopathologic factors.