根治性切除术后胃癌复发的发生率和模式：美国多机构分析。

Rates and patterns of recurrence after curative intent resection for gastric cancer: a United States multi-institutional analysis.

机构信息

Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.

Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA.

出版信息

J Am Coll Surg. 2014 Oct;219(4):664-75. doi: 10.1016/j.jamcollsurg.2014.03.062. Epub 2014 Jun 26.

DOI:10.1016/j.jamcollsurg.2014.03.062

PMID:25154671

Abstract

BACKGROUND

Reports on recurrence and outcomes of US patients with gastric cancer are scarce. The aim of this study was to determine incidence and pattern of recurrence after curative intent surgery for gastric cancer.

STUDY DESIGN

Using the multi-institutional US Gastric Cancer Collaborative database, we identified 817 patients undergoing curative intent resection for gastric cancer between 2000 and 2012. Patterns and rates of recurrence along with associated risk factors were identified using adjusted regression analysis. Recurrences were classified as locoregional, peritoneal, or hematogenous.

RESULTS

Median patient age was 65.8 years (interquartile range [IQR] 56.4, 74.7); the majority of patients were male (n = 462, 56.6%) and white (n = 511, 62.5%). At the time of surgery, the majority of patients underwent a partial gastrectomy (n = 481, 59.2%) with a complete R0 resection achieved in 91.6% (n = 748) of patients. At the time of last follow-up, 244 (29.9%) of 817 patients developed a recurrence; 163 (66.8%) patients had recurrence at only a single site; the remaining 81 (33.2%) had multiple sites of initial recurrence. Among patients who recurred at a single site, recurrence was most common at a distant location and included hematogenous (n = 57, 23.4%) or peritoneal (n = 47, 19.3%) only metastasis. Tumors at the gastroesophageal junction (odds ratio [OR] 3.18, 95% CI 1.08 to 9.40; p = 0.04) were associated with higher risk of locoregional recurrence, while the presence of multiple lesions (OR 10.82, 95% CI 3.56 to 32.85; p < 0.001) remained associated with an increased risk of distant hematogenous recurrence after adjusted analysis. Recurrence was associated with worse survival, with a median recurrence-free survival of 10.8 months (IQR 8.9, 12.8) among those who experienced a recurrence.

CONCLUSIONS

Nearly one-third of patients experienced recurrence after gastric cancer surgery. The most common site of recurrence was distant.

摘要

背景

美国胃癌患者的复发和结局报告很少。本研究旨在确定接受根治性手术治疗的胃癌患者的复发发生率和模式。

研究设计

使用多机构美国胃癌协作数据库，我们确定了 2000 年至 2012 年间接受根治性切除术治疗的 817 例胃癌患者。使用调整后的回归分析确定复发的模式和率以及相关的危险因素。复发分为局部区域、腹膜或血液转移。

结果

中位患者年龄为 65.8 岁（四分位距 [IQR] 56.4，74.7）；大多数患者为男性（n=462，56.6%）和白人（n=511，62.5%）。手术时，大多数患者接受了部分胃切除术（n=481，59.2%），91.6%（n=748）的患者完全达到了 R0 切除。在最后一次随访时，817 例患者中有 244 例（29.9%）发生了复发；163 例（66.8%）患者仅在单个部位复发；其余 81 例（33.2%）患者最初的复发部位为多个。在仅在单个部位复发的患者中，远处转移是最常见的复发部位，包括血液转移（n=57，23.4%）或腹膜转移（n=47，19.3%）。胃食管交界处的肿瘤（比值比 [OR] 3.18，95%置信区间 [CI] 1.08 至 9.40；p=0.04）与局部区域复发的风险增加相关，而多个病变的存在（OR 10.82，95%CI 3.56 至 32.85；p<0.001）在调整分析后仍与远处血液转移复发的风险增加相关。复发与生存预后较差相关，在发生复发的患者中，无复发生存中位数为 10.8 个月（IQR 8.9，12.8）。