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J Surg Oncol. 2016 Dec;114(7):859-864. doi: 10.1002/jso.24405. Epub 2016 Aug 11.

Recursive partition analysis of peritoneal and systemic recurrence in patients with gastric cancer who underwent D2 gastrectomy: Implications for neoadjuvant therapy consideration.

Author information

1
Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
2
Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea.
3
Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
4
Department of Radiology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
5
Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
6
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
7
Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea. WJHYUNG@yuhs.ac.
8
Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea. mdgold@yuhs.ac.

Abstract

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.

KEYWORDS:

gastrectomy; gastric cancer; recurrence; recursive partition analysis; survival

PMID:
27511744
DOI:
10.1002/jso.24405
[Indexed for MEDLINE]

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