Lauren Histologic Type Is the Most Important Factor Associated With Pattern of Recurrence Following Resection of Gastric Adenocarcinoma

Abstract

Objective: To examine sites of initial recurrence in patients after resection of gastric and gastroesophageal junction Siewert II/III adenocarcinoma (GA).

Background: There are few recent studies on recurrence for Western patients following potentially curative resection of GA.

Methods: A review of a prospectively maintained, single institution database was performed. Clinicopathologic factors, site(s) of initial recurrence, disease-free survival, and overall survival were examined.

Results: From January 2000 to June 2010, 957 patients underwent potentially curative resection for GA, 435 patients (46%) had recurrent disease, and complete data on recurrence site(s) could be obtained in 386 patients. Tumors were Lauren intestinal type in 206 (53%) and diffuse or mixed-type in 180 (47%). Median time to recurrence was 12 months and 75% of recurrences occurred within 2 years. There was a significant difference in pattern of initial recurrence between the intestinal and diffuse/mixed cohorts (P < 0.001). For intestinal tumors, distant metastasis was the most common site (54%), followed by locoregional (20%), peritoneal (15%), and multifocal (11%). For diffuse/mixed tumors, peritoneal recurrence was the most common (37%), followed by distant (32%), locoregional (22%), and multifocal (9%). On multivariate analysis, Lauren histologic type was the only significant factor that was associated with both peritoneal recurrence (diffuse, hazard ratio 2.22, confidence interval 1.38-3.94) and distant recurrence (intestinal, hazard ratio 1.888, confidence interval 1.202-2.966). After recurrence, median overall survival was only 8.4 months.

Conclusions: In GA patients who recur after resection, patterns of recurrence vary significantly based on Lauren histologic type.

Figure 1

CONSORT diagram of study population.

Figure 2

Venn diagram of recurrence patterns in all 386 patients (A), 206 patients with intestinal tumors (B), and 180 patients with diffuse/mixed tumors (C). Sizes of circles are proportional to number of patients.

Figure 3

Kaplan-Meier curves for disease-free survival (A), overall survival (B) and overall survival after recurrence (C) for intestinal vs. diffuse/mixed patients.