Tumor pT stage only independent predictor of late gastric cancer recurrence

Last Updated: 2016-01-13

By Reuters Staff

NEW YORK (Reuters Health) - Patients with pT4 stage gastric cancer are at increased risk of late recurrence, new research shows.

About 10% of patients with pT4 disease had recurrence more than five years after primary resection, Dr. Ju-Hee Lee of Hanyang University Hospital in Seoul, South Korea, and colleagues found. "According to our study, tumor depth may be an important indicator for long-term follow-up," they write.

Most deaths from gastric cancer are due to recurrence, which usually happens within two years of gastrectomy, the researchers note. Because recurrence after five years is rare, they add, close follow-up typically ends at that point. However, late relapse does occur; one study found a recurrence rate of 10.8% among five-year gastric cancer survivors.

To investigate factors associated with late gastric cancer recurrence, the researchers looked at 1,573 patients treated with curative surgery between 1992 and 2006, including 348 who had recurrence. Twenty-five (7.6%) had recurrence more than five years after surgery. Median time to recurrence among these patients was 88.8 months, while 18 had recurrence within eight years of surgery.

Multivariate analysis found pT classification was the only independent predictor of late recurrence. The rate of late recurrence was 0.4% with pT1, 1.7% with pT2-3, and 10.3% with pT4.

Peritoneal recurrence was the most common type of late recurrence, occurring in 19 of the 25 patients. This is different from past studies, the researchers note, which have found distant metastases to be the most common pattern.

"This may be explained by the relatively low rate of adjuvant chemotherapy in our study; among 387 patients indicated for adjuvant chemotherapy according to recent version of Japanese Gastric Cancer Association treatment guideline, only 282 received and 128 finished >80% of the planned cycle," Dr. Lee and colleagues write. Also, they note, 13 of the 23 patients with late recurrences for whom adjuvant chemotherapy was indicated did not receive treatment or did not finish it.

"Greater attention to peritoneal recurrence may be recommended in disease-free gastric cancer patients surviving >5 years after gastrectomy who did not receive adjuvant chemotherapy," the researchers say.

They conclude: "Whether extended follow-up for T4 tumors affects survival needs to be demonstrated in more large-scale studies."

The authors reported no funding or disclosures.

SOURCE: http://bit.ly/1OinwBa

Surgery 2015.