PV QA 1 - Poster Viewing Q&A 1
Purpose/Objective(s): To analyze the patterns of failure in patients with gastric cancer after radical gastrectomy and to map the frequency of different sites of loco-regional recurrence (LRR), so as to better define the patients with high risk of LRR and to provide information to improve target definition.
Materials/Methods: The medical history of 1112 patients receiving radical gastrectomy for stage I-III gastric cancer from January 2010 to December 2012 were retrospectively analyzed. No pre-operative systemic therapy was given. Median age at diagnosis was 59 years (range, 22-88). The median follow-up time was 28.3 months (range, 3-94).
Results: In total, 274 patients with 373 first events were identified within the follow up period, the median disease free interval (DFI) was 16.5 months (range, 3-88). Within these, LRR was found in 135 patients, distant metastasis (DM) in 124 patients and peritoneal dissemination (PD) in 114 patients. Eighty-five patients had more than one event of first failure. The number of patients with LRR only, DM only and PD only were 66, 59 and 64, respectively. By multivariate analysis, pN3, vessel invasion and elevated CEA level were associated with increased risk of LRR (p<0.05). Low differentiation in histology, increased CEA level and lack of adjuvant chemotherapy were associated with higher risk of DM (p<0.05). pT3/4, Bormann type IV and elevated CA-199 level were associated with increased risk of PD (p<0.05). In 135 patients with LRR , the median DFI was significantly shorter in patients with 2-3 risk factors than in patients with 0-1 risk factors (7.0-17.4 months vs 21.2-24.3 months, p<0.05). The 3-year LRR in patients with 0-1 and 2-3 risk factors were 46(5.6%), and 42(29.2%), p=0.002. Regional nodes recurrence represented the majority pattern of failure (95 patients), of which, No.16 nodes, that is the para-abdominal aorta nodes extended from the upper margin of the celiac trunk to the lower margin of the aortic bifurcation was the most frequent site (71 patients). Within these, 16a2 and 16b1 were even more prevalent (64 and 58 patients).
Conclusion: In this study we found that loco-regional recurrence remains an important part of recurrence in gastric cancer after curative resection. Adjuvant radiotherapy is recommended for locally advanced gastric cancer patients with pN3, vessel invasion or increased CEA level, particularly in patients with multiple risk factors for recurrence. Regional lymph nodes, especially No.16 lymph nodes represents the major pattern of failure in loco-regional recurrence. The postoperative radiation target should include these lymph nodes, especially a2 and b1 regions.
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