Analysis of risk factors of early recurrence and metastasis after radical resection of gastric cancer

doi:10.19401/j.cnki.1007-3639.2022.07.002

Abstract

Abstract:

Background and purpose: At present, gastric cancer is still an important cause of cancer death, and its postoperative recurrence is the main factor leading to the low survival rate of gastric cancer. The purpose of this study was to investigate the relationship between early and late postoperative recurrence and metastasis and clinicopathological features in patients with gastric cancer in order to improve the prognosis of gastric cancer. Methods: The clinicopathological data of 188 patients with recurrent and metastatic gastric cancer after radical operation in Zhejiang Cancer Hospital from January 2014 to January 2016 were analyzed retrospectively. The clinicopathological characteristics of patients with early recurrence and metastasis (≤2 years) and late recurrence and metastasis (>2 years) were compared. Results: Among the 188 patients, 126 patients had early recurrence and 62 patients had late recurrence. The overall median time of recurrence was 18 months after operation. Recurrence site, lymph node metastasis, serosa infiltration, no preoperative neoadjuvant chemotherapy, no postoperative adjuvant chemotherapy and poor differentiation are independent risk factors for early postoperative recurrence of gastric cancer. Conclusion: The location of recurrence, preoperative neoadjuvant chemotherapy, postoperative adjuvant chemotherapy, lymph node metastasis, depth of invasion and degree of tissue differentiation are related to postoperative recurrence.

Key words: Gastric cancer, Postoperative recurrence, Risk factors, Prognosis

CLC Number:

R735.2

CAO Mengxuan, HU Can, ZHANG Yanqiang, HUANG Ling, DU Yian, YU Pengcheng, ZHANG Ruolan, XU Zhiyuan, CHENG Xiangdong. Analysis of risk factors of early recurrence and metastasis after radical resection of gastric cancer[J]. China Oncology, 2022, 32(7): 588-595.

Figures/Tables 5

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References 32

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Data	Case n	Data	Case n
Gender		Body	48
Male	136	Antrum	94
Female	52	Cardiac	43
Age/year		Full	3
≥60	99	Borrmann type
<60	89	Ⅰ	4
Chronic illness		Ⅱ	102
Yes	54	Ⅲ	52
No	134	Ⅳ	30
Drinking history		Site of recurrence
Yes	64	Liver	30
No	124	Abdominal	95
Smoking history		Other mode	63
Yes	88	Lymph node metastasis
No	100	N₀	26
Preoperative chemotherapy		N₁	20
Yes	53	N₂	40
No	135	N₃	102
Postoperative chemotherapy		Vascular tumor thrombus
Yes	148	Positive	117
No	40	Negative	71
Reconstruction		Nerve infiltration
Billroth Ⅰ	67	Positive	137
Billroth Ⅱ	21	Negative	51
Roux-en-Y	100	Serosa infiltration
Tumor length/cm		Positive	152
≥3	168	Negative	36
<3	20	Number of lymph nodes
Signet-ring cell carcinoma		>12	51
Yes	79	≤12	137
No	109	cTNM stage
Differentiated degree		Ⅰ	4
Low-medium	115	Ⅱ	31
Medium-high	73	Ⅲ	148
Primary site		Ⅳ	5

Data	Early recurrence (n=126)	Late recurrence (n=62)	χ²	P value
Age/year
≥60	68	31	0.262	0.608
<60	58	31	0.262	0.608
Gender
Male	97	39	4.118	0.042
Female	29	23	4.118	0.042
Reconstruction
Billroth Ⅰ	37	30	6.607	0.037
Billroth Ⅱ	15	6
Roux-en-Y	74	26
Serosa infiltration
Positive	114	38	22.862	0.000
Negative	12	24	22.862	0.000
Preoperative chemotherapy
Yes	27	26	8.632	0.003
No	99	36	8.632	0.003
Tumor length/cm
≥3	118	50	7.393	0.007
<3	8	12	7.393	0.007
Site of recurrence
Liver	27	3	8.561	0.014
Abdominal	59	36
Other mode	40	23
Number of lymph nodes
>12	42	9	7.443	0.006
≤12	84	53	7.443	0.006
Differentiated degree
Low-medium	87	28	9.982	0.002
Medium-high	39	34	9.982	0.002

Data	P value (univariate)	HR (multivariate)	95% CI (multivariate)	P value (multivariate)
Age/year
≥60	0.532
<60	0.532
Gender
Male	0.217
Female	0.217
Preoperative chemotherapy
Yes	0.000	0.467	0.313-0.699	0.000
No	0.000	0.467	0.313-0.699	0.000
Postoperative chemotherapy
Yes	0.047	0.692	0.492-0.973	0.034
No	0.047	0.692	0.492-0.973	0.034
Tumor length/cm
≥3	0.033	1.460	0.905-2.355	0.121
<3	0.033	1.460	0.905-2.355	0.121
Number of lymph nodes
>12	0.001	1.886	1.313-2.709	0.001
≤12	0.001	1.886	1.313-2.709	0.001
Signet-ring cell carcinoma
Yes	0.626
No	0.626
Primary site
Body	0.105
Antrum
Cardiac
Full
Serosa infiltration
Positive	0.000	2.047	1.333-3.144	0.001
Negative	0.000	2.047	1.333-3.144	0.001
Nerve infiltration
Positive	0.020	0.802	0.557-1.155	0.236
Negative	0.020	0.802	0.557-1.155	0.236
Site of recurrence
Liver	0.030	1.290	1.006-1.654	0.045
Abdominal
Other mode
Differentiated degree
Low-medium	0.000	1.475	1.068-2.037	0.018
Medium-high	0.000	1.475	1.068-2.037	0.018
Vascular tumor thrombus
Positive	0.187
Negative	0.187