Sawayama Hiroshi, Iwatsuki Masaaki, Kuroda Daisuke, Toihata Tasuku, Uchihara Tomoyuki, Koga Yuki, Yagi Taisuke, Kiyozumi Yuki, Eto Tsugio, Hiyoshi Yukiharu, Ishimoto Takatsugu, Baba Yoshifumi, Miyamoto Yuji, Yoshida Naoya, Baba Hideo
Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
Surg Today. 2018 Nov;48(11):994-1003. doi: 10.1007/s00595-018-1684-1. Epub 2018 Jun 20.
This study investigated the predictors associated with early recurrence (i.e. within 12 months) after curative gastrectomy for gastric cancer (GC).
We evaluated the clinicopathological factors in 429 patients who underwent curative gastrectomy for GC without preoperative chemotherapy and analyzed these factors' associations with early recurrence.
Of 429 patients, 57 experienced recurrences, which were associated with gender, diameter, depth of invasion, lymph node (LN) metastasis, the LN ratio (LNr; LNs with metastasis/dissected LNs), lymphatic invasion, vascular invasion, carbohydrate antigen 19-9 (CA19-9) levels, C-reactive protein levels and the neutrophil/lymphocyte ratio. Twenty-one patients (36.8%) recurred within 12 months. Early recurrence was associated with a high LNr (P = 0.0020) and high CA19-9 levels (P = 0.0415). The other factors were not significantly associated with early recurrence. The 12-month recurrence rate was 33.9% in patients with a high LNr and 1.9% in those with a low LNr and 20.3% in patients with high CA19-9 levels and 3.5% in those with low CA19-9 levels. The 12-month recurrence rate was 62.5% in patients with a high LNr and high CA19-9 levels, 18.4% in those with a high LNr or high-CA19-9 levels, and 1.4% in those with a low LNr and low CA19-9 levels.
LNr ≥ 0.15 and CA19-9 ≥ 37 U/ml were effective surrogate markers for predicting early recurrence.
本研究调查了胃癌（GC）根治性胃切除术后早期复发（即12个月内）的相关预测因素。
我们评估了429例未接受术前化疗而行GC根治性胃切除术患者的临床病理因素，并分析了这些因素与早期复发的相关性。
429例患者中，57例出现复发，复发与性别、肿瘤直径、浸润深度、淋巴结（LN）转移、LN比率（LNr；转移淋巴结数/清扫淋巴结数）、淋巴管浸润、血管浸润、糖类抗原19-9（CA19-9）水平、C反应蛋白水平及中性粒细胞/淋巴细胞比率有关。21例患者（36.8%）在12个月内复发。早期复发与高LNr（P = 0.0020）和高CA19-9水平（P = 0.0415）有关。其他因素与早期复发无显著相关性。LNr高的患者12个月复发率为33.9%，LNr低的患者为1.9%；CA19-9水平高的患者12个月复发率为20.3%，CA19-9水平低的患者为3.5%。LNr高且CA19-9水平高的患者12个月复发率为62.5%，LNr高或CA19-9水平高的患者为18.4%，LNr低且CA19-9水平低的患者为1.4%。
LNr≥0.15和CA19-9≥37 U/ml是预测早期复发的有效替代标志物。
