Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jan;267(1):105-113.
doi: 10.1097/SLA.0000000000002040.

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

Jun H Lee  1   2 , Kevin K Chang  1 , Changhwan Yoon  1 , Laura H Tang  3 , Vivian E Strong  1 , Sam S Yoon  1
Affiliations

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

Jun H Lee et al. Ann Surg. 2018 Jan.

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.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: The authors declare they have no conflicts of interest.

Figures

Figure 1
Figure 1
CONSORT diagram of study population.
Figure 2
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
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.
See this image and copyright information in PMC

References

    1. Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90. - PubMed
    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65:5–29. - PubMed
    1. Bang YJ, Kim YW, Yang HK, et al. Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial. Lancet. 2012;379:315–321. - PubMed
    1. Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355:11–20. - PubMed
    1. Macdonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001;345:725–730. - PubMed

MeSH terms