Nobre Karolyne Ernesto Luiz, Pereira Marina Alessandra, Ramos Marcus Fernando Kodama Pertille, Ribeiro Ulysses, Zilberstein Bruno, Cecconello Ivan, Dias André Roncon
School of Medical Sciences, UNIFACISA, Medicine, Campina Grande, PB, Brazil.
Cancer Institute, Hospital das Clinicas, University of São Paulo, São Paulo, SP, Brazil.
Arq Bras Cir Dig. 2021 May 14;34(1):e1562. doi: 10.1590/0102-672020210001e1562. eCollection 2021.
Nearly 10% of node negative gastric cancer patients who underwent curative surgery have disease recurrence. Western data is extremely poor on this matter and identifying the risk factors that associate with relapse may allow new strategies to improve survival.
Verify the clinical and pathological characteristics that correlate with recurrence in node negative gastric cancer.
All gastric cancer patients submitted to gastrectomy between 2009 and 2019 at our institution and pathologically classified as N0 were considered. Their data were available in a prospective database. Inclusion criteria were: gastric adenocarcinoma, node negative, gastrectomy with curative intent, R0 resection. Main outcomes studied were: disease-free survival and overall survival.
A total of 270 patients fulfilled the inclusion criteria. Mean age was 63-year-old and 155 were males. Subtotal gastrectomy and D2 lymphadenectomy were performed in 64% and 74.4%, respectively. Mean lymph node yield was 37.6. Early GC was present in 54.1% of the cases. Mean follow-up was 40.8 months and 19 (7%) patients relapsed. Disease-free survival and overall survival were 90.9% and 74.6%, respectively. Independent risk factors for worse disease-free survival were: total gastrectomy, lesion size ≥3.4 cm, higher pT status and <16 lymph nodes resected.
In western gastric cancer pN0 patients submitted to gastrectomy, lymph node count <16, pT3-4 status, tumor size ≥3.4 cm, total gastrectomy and presence of lymphatic invasion, are all risk factors for disease relapse.
接受根治性手术的淋巴结阴性胃癌患者中，近10%会出现疾病复发。西方在这方面的数据极其匮乏，识别与复发相关的风险因素可能有助于制定提高生存率的新策略。
验证与淋巴结阴性胃癌复发相关的临床和病理特征。
纳入2009年至2019年在本机构接受胃切除术且病理分类为N0的所有胃癌患者。他们的数据可在一个前瞻性数据库中获取。纳入标准为：胃腺癌、淋巴结阴性、根治性胃切除术、R0切除。研究的主要结局为：无病生存期和总生存期。
共有270例患者符合纳入标准。平均年龄为63岁，男性155例。分别有64%和74.4%的患者接受了胃次全切除术和D2淋巴结清扫术。平均淋巴结检出数为37.6。54.1%的病例为早期胃癌。平均随访40.8个月，19例（7%）患者复发。无病生存期和总生存期分别为90.9%和74.6%。无病生存期较差的独立危险因素为：全胃切除术、病变大小≥3.4 cm、较高的pT分期和切除淋巴结<16枚。
在接受胃切除术的西方胃癌pN0患者中，淋巴结计数<16枚、pT3 - 4分期、肿瘤大小≥3.4 cm、全胃切除术和存在淋巴侵犯均为疾病复发的危险因素。
