Lauren Histologic Type Is the Most Important Factor Associated With Pattern of Recurrence Following Resection of Gastric Adenocarcinoma.
Lauren Histologic Type Is the Most Important Factor Associated With Pattern of Recurrence Following Resection of Gastric Adenocarcinoma.
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DOI：
10.1097/sla.0000000000002040
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发表时间：
2018-01
影响因子：
9
通讯作者：
Yoon SS
中科院分区：
文献类型：
--
作者：
Lee JH;Chang KK;Yoon C;Tang LH;Strong VE;Yoon SS
To examine sites of initial recurrence in patients after resection of gastric and gastroesophageal junction Siewert II/III adenocarcinoma (GA). There are few recent studies on recurrence for Western patients following potentially curative resection of GA. A review of a prospectively maintained, single institution database was performed. Clinicopathologic factors, site(s) of initial recurrence, disease-free survival (DFS), and overall survival (OS) were examined. From January 2000–June 2010, 957 patients underwent potentially curative resection for GA, 435 patients (46%) had recurrent disease, and complete data on recurrence site(s) could be obtained in 386 patients. Tumors were Lauren intestinal type in 206 (53%) and diffuse or mixed-type in 180 (47%). Median time to recurrence was 12 months and 75% of recurrences occurred within 2 years. There was a significant difference in pattern of initial recurrence between the intestinal and diffuse/mixed cohorts (p = <0.001). For intestinal tumors, distant metastasis was the most common site (54%), followed by locoregional (20%), peritoneal (15%), and multifocal (11%). For diffuse/mixed tumors, peritoneal recurrence was the most common (37%), followed by distant (32%), locoregional (22%), and multifocal (9%). On multivariate analysis, Lauren histologic type was the only significant factor that was associated with both peritoneal recurrence (diffuse, HR 2.22, CI 1.38–3.94) and distant recurrence (intestinal, HR 1.888, CI 1.202–2.966). After recurrence, median OS was only 8.4 months. In GA patients who recur after resection, patterns of recurrence vary significantly based on Lauren histologic type. For patients with gastric adenocarcinoma, an improved ability to predict sites of recurrence after surgical resection may help determine adjuvant treatment and surveillance options. In our analysis of 386 patients with recurrence after potentially curative resection at a single Western institution, Lauren histologic type (intestinal vs. diffuse/mixed) was the most important factor in the pattern of initial recurrence.
