Recurrence of early gastric cancer. Follow-up of 1475 patients and review of the Japanese literature

Abstract

Background: The outcome of surgical treatment for early gastric cancer (EGC) generally is considered to be satisfactory. Although a small percentage of patients experience disease recurrence, the absolute number of such instances is too small for assessment of risk factors.

Methods: The authors investigated the follow-up records of 1475 patients with EGC treated at the National Cancer Center, Tokyo, with special reference to cancer recurrence. In addition, 20 Japanese reports on this subject were reviewed.

Results: Excluding operative deaths and patients with noncurative operations, 20 (1.4%) patients died of recurrent disease. The death rate associated with other causes (6.6%), including other malignant diseases, surpassed that associated with disease recurrence. Late recurrence (after 5 years) was seen in seven patients. By combining the data of patients reported in 20 articles in the literature, the authors estimated a recurrence rate for EGC of at least 1.9%, exclusive of cancers arising in the gastric stump. The incidence of recurrence was significantly higher in submucosal (3.6%), node-positive (10.7%), and histologically differentiated carcinomas (2.3%) than in mucosal, node-negative, and undifferentiated groups, respectively. Analysis of 123 instances of recurrent disease, the details of which had been reported, revealed that hematogenous metastasis was the most common mode of recurrence. The mean survival period of patients with recurrent disease was 40 months, and 23% of patients died more than 5 years after surgery.

Conclusion: It is rare for EGC to recur, even in patients with tumors with a comparatively high risk of recurrence. Long-term follow-up of patients with positive nodes for hematogenous spread might facilitate early detection of disease recurrence.