The prognostic value of detecting symptomatic or asymptomatic recurrence in patients with gastric cancer after a curative gastrectomy

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• 作者：Ahmet Bilici ; MD^a ; ^{ahmetknower@yahoo.com} ; Tarik Salman ; MD^b ; Bala Basak Oven Ustaalioglu ; MD^a ; Tugba Unek ; MD^b ; Mesut Seker ; MD^a ; Mehmet Aliustaoglu ; MD^a ; Cem Gezen ; MD^c ; Tarkan Unek ; MD^d ; Dilek Yavuzer ; MD^e ; Mehtat Unlu ; MD^f ; Mahmut Gumus ; MD^a ; Ugur Yilmaz ; MD^b
• 关键词：Gastric cancer ; Symptoms ; Recurrence ; Prognosis ; Survival
• 刊名：Journal of Surgical Research
• 出版年：2013
• 出版时间：March, 2013
• 年：2013
• 卷：180
• 期：1
• 页码：e1-e9
• 全文大小：240 K

文摘

Background

Although studies have investigated whether a routine follow-up should be performed after a gastrectomy, no consensus has been reached on the significance of the follow-up or the optimal surveillance protocol. In the present study, we evaluated the significance of the presence or absence of symptoms in the detection of recurrences after curative gastrectomy for gastric cancer.

Methods

We retrospectively analyzed 173 patients with recurrent gastric cancer who underwent radical gastrectomy. We evaluated the prognostic significance of the presence of cancer-related symptoms at the diagnosis of recurrence, and the relationship between the presence of symptoms and other clinicopathological factors.

Results

We detected a symptomatic recurrence in 42.2 % of patients. The presence of symptoms were significantly correlated with tumor size, pT stage, pN stage, pathologic stage, and short disease-free interval (<12 mo). The median disease-free survival (DFS), post-recurrence survival (PRS), and overall survival (OS) times for patients with asymptomatic recurrence were significantly longer than those of patients with symptomatic recurrence (disease-free survival was corrected as DFS, 11.1 versus 9.3 mo, P < 0.001; PRS, 4.9 versus 3.1 mo, P = 0.02; OS, 18.3 versus 12.3 mo, P = 0.001, respectively). Multivariate analysis showed that the presence of cancer-related symptoms (P = 0.033; hazard ratio [HR], 0.81) was an independent prognostic factor for PRS, as were short disease-free intervals (P < 0.001; HR, 2.42), age (P = 0.02; HR, 1.53), and the presence of chemotherapy in recurrence (P = 0.001; HR, 0.49). In addition, multivariate analysis indicated that the presence of symptoms, short disease-free interval, and age were also independent prognostic indicators for OS.

Conclusions

Our results demonstrate that symptomatic recurrence is an important prognostic factor for PRS of patients with gastric cancer after a curative gastrectomy. The presence of symptomatic recurrence may be a new and beneficial prognostic marker to evaluate biologic aggressiveness, which is an important determinant of survival at the time of recurrence diagnosis during a follow-up for gastric cancer.