Cancer Prevention Center, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
Cancer Med. 2021 May;10(10):3249-3260. doi: 10.1002/cam4.3899. Epub 2021 May 1.
The effect of long-term surveillance for asymptomatic patients after curative resection of gastric cancer is being debated. We compared the prognosis of Korean patients with recurrent gastric cancer according to the presence or absence of cancer-related symptoms at the time of recurrence detection.
We retrospectively reviewed the medical records of 305 Korean patients who experienced recurrence after curative resection of primary gastric cancer between March 2002 and February 2017 at Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
The median follow-up duration was 169.8 months (1-267.2), and the median age at first recurrence was 58.1 years (23.4-81.9). Among 305 patients with recurrence, 97 of 231 (42.0%) patients with early recurrence (≤5 years after curative surgical resection) and 47 of 74 (63.5%) patients with late recurrence (>5 years after curative surgical resection) had cancer-related symptoms at recurrence (p = 0.001). For survival after recurrence, detection of asymptomatic recurrence was an independent favorable factor (hazard ratio, 0.527; 95% confidence interval, 0.409-0.681; p < 0.001) accompanied with the possibility of subsequent treatment, targeted-, or immunotherapy for recurrent disease, and locoregional recurrence only. In the late-recurrence group, the patients with asymptomatic detection of recurrence showed favorable post-recurrence survival (median, 33.3 months vs. 14.7 months; p = 0.002), overall survival (median, 136.3 months vs. 106.1 months; p = 0.010), and cancer-specific survival (median, 177.5 months vs. 106.1 months; p = 0.005) than the patients with symptomatic detection.
The detection of gastric cancer recurrence in patients without cancer-related symptoms may be related to improved survival, suggesting the potential benefit of long-term surveillance.
对于根治性切除术后无症状患者进行长期监测的效果仍存在争议。我们比较了韩国患者在复发时是否存在与癌症相关的症状，以评估其复发后预后的差异。
我们回顾性分析了 2002 年 3 月至 2017 年 2 月期间在韩国首尔延世大学医学院延世癌症中心接受原发性胃癌根治性切除术后复发的 305 例韩国患者的病历资料。
中位随访时间为 169.8 个月（1-267.2），首次复发的中位年龄为 58.1 岁（23.4-81.9）。在 305 例复发患者中，231 例早期复发（根治性手术切除后≤5 年）患者中有 97 例（42.0%）和 74 例晚期复发（根治性手术切除后>5 年）患者中有 47 例（63.5%）在复发时存在与癌症相关的症状（p=0.001）。对于复发后的生存情况，无症状复发的检测是一个独立的有利因素（风险比，0.527；95%置信区间，0.409-0.681；p<0.001），并可能会接受针对复发性疾病的后续治疗、靶向治疗或免疫治疗，以及局部复发。在晚期复发组中，无症状检测到复发的患者在复发后的生存（中位，33.3 个月比 14.7 个月；p=0.002）、总生存（中位，136.3 个月比 106.1 个月；p=0.010）和癌症特异性生存（中位，177.5 个月比 106.1 个月；p=0.005）方面均优于有症状检测到复发的患者。
在无癌症相关症状的患者中检测到胃癌复发可能与改善生存有关，这提示长期监测可能具有潜在的益处。
