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Early and late recurrence after gastrectomy for gastric carcinoma
Author(s) -
Shiraishi Norio,
Inomata Masafumi,
Osawa Naofumi,
Yasuda Kazuhiro,
Adachi Yosuke,
Kitano Seigo
Publication year - 2000
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(20000715)89:2<255::aid-cncr8>3.0.co;2-n
Subject(s) - medicine , gastrectomy , stage (stratigraphy) , lymph node , dissection (medical) , multivariate analysis , carcinoma , lymphovascular invasion , gastroenterology , cancer , lymphatic system , surgery , lymph , metastasis , pathology , paleontology , biology
BACKGROUND To the authors' knowledge, there are few studies regarding the predictors of early and late recurrence after gastrectomy for gastric carcinoma, and it is unknown whether prognostic factors can be applied to the timing of recurrence. The current study analyzed patients who died of recurrent gastric carcinoma and clarified histopathologic indicators associated with early and late recurrence. METHODS The study included 138 patients who died of recurrent gastric carcinoma after gastrectomy that was performed in the Department of Surgery I, Oita Medical University, between 1982–1995. Clinicopathologic findings were compared between 104 patients who died within 2 years after gastrectomy (early recurrence group) and 34 patients who died > 2 years after gastrectomy (late recurrence group). Multivariate analysis was performed to determine the independent factors correlated with the timing of recurrence. RESULTS When compared with the late recurrence group, the early recurrence group was characterized by a tumor size ≥ 5 cm (92% in the early recurrence group vs. 74% in the late recurrence group), positive lymphatic invasion (64% vs. 38%), extended lymph node metastasis (73% vs. 35%), Stage III or IV disease (87% vs. 62%), and limited lymph node dissection (32% vs. 3%). The mean survival time was influenced by the lymphatic invasion ( P < 0.01), vascular invasion ( P < 0.05), level of lymph node metastasis ( P < 0.01), stage of disease ( P < 0.01), and extent of lymph node dissection ( P < 0.01). On multivariate analysis, survival time was found to be associated independently with the stage of disease (Stage I, II vs. Stage III, IV) or the level of lymph node metastasis (N0, N1 vs. N2, N3). CONCLUSIONS The stage of disease and level of lymph node metastasis were found to be the most significant factors independently associated with the survival time after gastrectomy for gastric carcinoma. Patients with more advanced stage of disease (Stage III, IV) or those with extended lymph node metastasis (N2, N3) frequently died of recurrence within 2 years after gastrectomy. Cancer 2000;89:255–61. © 2000 American Cancer Society.