Researchers investigated whether the risk of gastric cancer recurrence, following surgical resection, can be predicted.
Patients who underwent resection for gastric cancer were stratified according to several categories. These were curability of surgery (curative [R0] vs. non-curative resection), extent of surgery (limited [D1] vs. extended [D2] node dissection), and pathological nodal/serosal status.
Curative resection only produced a chance of cure, while survival was very poor following non-curative resection.
|Recurrence-risk is very high in serosa- and node-positive gastric cancers.
|British Journal of Cancer|
For the D2 R0 subgroup of patients, a classification system, based upon pathological serosa and node state, proved to be of clinical implication.
Risk of recurrence after a median follow-up of 92 months was measured. This was low among patients with both serosa and node-negative cancer (Group 1, 11%), and moderate among those with either serosa or node-positive cancer (Group 2, 53%). The risk was very high among patients with both serosa and node-positive cancer (Group 3, 83%).
The relative risks of recurrence and death from gastric cancer, among patients in Groups 2 and 3, as compared to those Group 1, were 7.1 and 16.2 respectively.
Analysis of first site-specific recurrence made several revelations. The researchers found there was a low rate of loco-regional recurrence alone (12%). The serosa state was also a determinant factor in site recurrence. In addition, the presence of nodal metastases was associated with all types of cancer recurrence.
D. H. Roukos concluded on behalf of the group, "Our findings demonstrate that a pathological serosa- and node-based classification is very simple and accurately predicts site-specific recurrence-risks.
"Furthermore, they reveal that risk of recurrence following curative D2 surgery alone is low for serosa- and node-negative cancers. However, it is very high in serosa- and node-positive cancers, suggesting the need for new therapeutic strategies in this subgroup of patients."