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Recursive partition analysis of peritoneal and systemic recurrence in patients with gastric cancer who underwent D2 gastrectomy: Implications for neoadjuvant therapy consideration
Author(s) -
Chang Jee Suk,
Kim Kyung Hwan,
Keum Ki Chang,
Noh Sung Hoon,
Lim Joon Seok,
Kim Hyo Song,
Rha Sun Young,
Lee Yong Chan,
Hyung Woo Jin,
Koom Woong Sub
Publication year - 2016
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24405
Subject(s) - medicine , gastrectomy , stage (stratigraphy) , cancer , gastroenterology , systemic therapy , adjuvant therapy , surgery , adjuvant , oncology , breast cancer , biology , paleontology
Background and Objectives To classify patients with nonmetastatic advanced gastric cancer who underwent D2‐gastrectomy into prognostic groups based on peritoneal and systemic recurrence risks. Methods Between 2004 and 2007, 1,090 patients with T3–4 or N+ gastric cancer were identified from our registry. Recurrence rates were estimated using a competing‐risk analysis. Different prognostic groups were defined using recursive partitioning analysis (RPA). Results Median follow‐up was 7 years. In the RPA‐model for peritoneal recurrence risk, the initial node was split by T stage, indicating that differences between patients with T1–3 and T4 cancer were the greatest. The 5‐year peritoneal recurrence rates for patients with T4 (n = 627) and T1–3 (n = 463) disease were 34.3% and 9.1%, respectively. N stage and neural invasion had an additive impact on high‐risk patients. The RPA model for systemic relapse incorporated N stage alone and gave two terminal nodes: N0–2 (n = 721) and N3 (n = 369). The 5‐year cumulative incidences were 7.7% and 24.5%, respectively. Conclusions We proposed risk stratification models of peritoneal and systemic recurrence in patients undergoing D2‐gastrectomy. This classification could be used for stratification protocols in future studies evaluating adjuvant therapies such as preoperative chemoradiotherapy. J. Surg. Oncol. 2016;114:859–864 . © 2016 2016 Wiley Periodicals, Inc.