RECURRENCE IN PN0 GASTRIC CANCER: RISK FACTORS IN THE OCCIDENT <span class="so-article-trans-title"> Translated title: RECORR&Ecirc;NCIA NO C&Acirc;NCER G&Aacute;STRICO pN0: FATORES DE RISCO NO OCIDENTE </span>

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ABSTRACT

Background:

Nearly 10% of node negative gastric cancer patients who underwent curative surgery have disease recurrence. Western data is extremely poor on this matter and identifying the risk factors that associate with relapse may allow new strategies to improve survival.

Aim:

Verify the clinical and pathological characteristics that correlate with recurrence in node negative gastric cancer.

Methods:

All gastric cancer patients submitted to gastrectomy between 2009 and 2019 at our institution and pathologically classified as N0 were considered. Their data were available in a prospective database. Inclusion criteria were: gastric adenocarcinoma, node negative, gastrectomy with curative intent, R0 resection. Main outcomes studied were: disease-free survival and overall survival.

Results:

A total of 270 patients fulfilled the inclusion criteria. Mean age was 63-year-old and 155 were males. Subtotal gastrectomy and D2 lymphadenectomy were performed in 64% and 74.4%, respectively. Mean lymph node yield was 37.6. Early GC was present in 54.1% of the cases. Mean follow-up was 40.8 months and 19 (7%) patients relapsed. Disease-free survival and overall survival were 90.9% and 74.6%, respectively. Independent risk factors for worse disease-free survival were: total gastrectomy, lesion size ≥3.4 cm, higher pT status and <16 lymph nodes resected.

Conclusion:

In western gastric cancer pN0 patients submitted to gastrectomy, lymph node count <16, pT3-4 status, tumor size ≥3.4 cm, total gastrectomy and presence of lymphatic invasion, are all risk factors for disease relapse.

RESUMO

Racional:

Aproximadamente 10% dos pacientes com câncer gástrico submetidos a operação curativa e sem linfonodos acometidos irão apresentam recorrência da doença. Os dados ocidentais são extremamente pobres sobre este assunto e a identificação dos fatores de risco associados à recidiva podem permitir novas estratégias para melhorar a sobrevida.

Objetivo:

Identificar as características clínicas e patológicas que se correlacionam com recidiva em pacientes com câncer gástrico pN0.

Métodos:

Foram considerados todos os pacientes com câncer gástrico submetidos à gastrectomia entre 2009 e 2019 em nossa instituição e que na classificação patológica não apresentaram acometimento linfonodal. Os critérios de inclusão foram: adenocarcinoma gástrico, pN0, gastrectomia com intenção curativa, ressecção R0. Os principais desfechos estudados foram: sobrevida livre de doença e sobrevida global.

Resultados:

Ao todo 270 pacientes preencheram os critérios de inclusão. A idade média foi de 63 anos e 155 eram homens. A gastrectomia subtotal e a linfadenectomia D2 foram realizadas em 64% e 74,4%, respectivamente. A média de linfonodos ressecados foi de 37,6. Câncer gástrico precoce estava presente em 54,1% dos casos. O seguimento médio foi de 40,8 meses e 19 (7%) apresentaram recidiva. A sobrevida livre de doença e sobrevida global foram de 90,9% e 74,6%, respectivamente. Os fatores de risco independentes para pior sobrevida livre de doença foram: gastrectomia total, lesão ≥3,4 cm, status pT avançado e <16 linfonodos ressecados.

Conclusão:

Os fatores de risco para recidiva no grupo estudado foram: <16 linfonodos ressecados, status pT3-4, tumor ≥3,4 cm, gastrectomia total e presença de invasão linfática.

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Most cited references 32

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A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation

Mary Charlson, Peter Pompei, Kathy Ales … (1987)

The objective of this study was to develop a prospectively applicable method for classifying comorbid conditions which might alter the risk of mortality for use in longitudinal studies. A weighted index that takes into account the number and the seriousness of comorbid disease was developed in a cohort of 559 medical patients. The 1-yr mortality rates for the different scores were: "0", 12% (181); "1-2", 26% (225); "3-4", 52% (71); and "greater than or equal to 5", 85% (82). The index was tested for its ability to predict risk of death from comorbid disease in the second cohort of 685 patients during a 10-yr follow-up. The percent of patients who died of comorbid disease for the different scores were: "0", 8% (588); "1", 25% (54); "2", 48% (25); "greater than or equal to 3", 59% (18). With each increased level of the comorbidity index, there were stepwise increases in the cumulative mortality attributable to comorbid disease (log rank chi 2 = 165; p less than 0.0001). In this longer follow-up, age was also a predictor of mortality (p less than 0.001). The new index performed similarly to a previous system devised by Kaplan and Feinstein. The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death from comorbid disease for use in longitudinal studies. Further work in larger populations is still required to refine the approach because the number of patients with any given condition in this study was relatively small.

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Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.

Daniel Dindo, Nicolas Demartines, Pierre-Alain Clavien (2004)

Although quality assessment is gaining increasing attention, there is still no consensus on how to define and grade postoperative complications. This shortcoming hampers comparison of outcome data among different centers and therapies and over time. A classification of complications published by one of the authors in 1992 was critically re-evaluated and modified to increase its accuracy and its acceptability in the surgical community. Modifications mainly focused on the manner of reporting life-threatening and permanently disabling complications. The new grading system still mostly relies on the therapy used to treat the complication. The classification was tested in a cohort of 6336 patients who underwent elective general surgery at our institution. The reproducibility and personal judgment of the classification were evaluated through an international survey with 2 questionnaires sent to 10 surgical centers worldwide. The new ranking system significantly correlated with complexity of surgery (P < 0.0001) as well as with the length of the hospital stay (P < 0.0001). A total of 144 surgeons from 10 different centers around the world and at different levels of training returned the survey. Ninety percent of the case presentations were correctly graded. The classification was considered to be simple (92% of the respondents), reproducible (91%), logical (92%), useful (90%), and comprehensive (89%). The answers of both questionnaires were not dependent on the origin of the reply and the level of training of the surgeons. The new complication classification appears reliable and may represent a compelling tool for quality assessment in surgery in all parts of the world.