Reappraise role of lymph node status in patterns of recurrence following curative resection of gastric adenocarcinoma |
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Authors: | Yihui Tang Jianxian Lin Junpeng Lin Jiabin Wang Jun Lu Qiyue Chen Longlong Cao Mi Lin Ruhong Tu Changming Huang Ping Li Chaohui Zheng Jianwei Xie |
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Affiliation: | 1. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 2. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou 350108, China |
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Abstract: | ObjectiveTo examine the association between lymph node status and recurrence patterns in completely resected gastric adenocarcinoma.MethodsWe retrospectively assessed 1,694 patients who underwent curative gastrectomy from January 2010 to August 2014. Patients stratified according to lymph node status and recurrence patterns among different subgroups were compared.ResultsOf all, 517 (30.5%) patients developed recurrent disease, and complete data of recurrence could be obtained in 493 (95.4%) patients. For pN0 patients, the patterns of recurrence were different according to pT stage: locoregional recurrence was most common in patients with pT1−2 disease (57.1%), distant recurrence was most common in patients with pT3 disease (57.1%), and peritoneal recurrence was most common in patients with pT4a disease (66.7%). For pN+ patients, distant metastasis was most common pattern irrespective of pT stage. The site-specific trend of recurrence showed that locoregional recurrence increased within 5 years in patients with pN0−2 disease but plateaued 3 years after surgery in patients with pN3 disease. Time to recurrence was significantly longer for the pN0 patients compared with the pN+ patients (median: 25 vs. 16 months, P=0.001). Moreover, post-recurrence survival was significantly better for the pN0 patients than for the pN+ patients (median: 12 vs. 6 months, P<0.001), especially in patients with non-peritoneal recurrence, late recurrence, single recurrence, and receipt of potential curative treatment. ConclusionsAmong clinicopathologic factors, lymph node status is the most important factor associated with recurrence patterns after curative gastrectomy. Lymph node status may be used as an adjunct in clinical decision-making about postoperative therapeutic and follow-up strategies. |
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Keywords: | Recurrence patterns lymph node status post-recurrence survival recurrence-free survival gastric cancer |
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