Factors associated with recurrence and survival in lymph node-negative gastric adenocarcinoma: A 7-institution study of the us gastric cancer collaborative

Linda X. Jin, Lindsey E. Moses, M. Hart Squires, George A. Poultsides, Konstantinos Votanopoulos, Sharon M. Weber, Mark Bloomston, Timothy M. Pawlik, William G. Hawkins, David C. Linehan, Steven M. Strasberg, Carl Schmidt, David J. Worhunsky, Alexandra W. Acher, Kenneth Cardona, Clifford S. Cho, David A. Kooby, Edward Levine, Emily R. Winslow, Neil D. SaundersGaya Spolverato, Shishir K. Maithel, Ryan C. Fields

Research output: Contribution to journalArticle

Abstract

Objectives: To determine pathologic features associated with recurrence and survival in patients with lymph node-negative gastric adenocarcinoma. Study Design: Multi-institutional retrospective analysis. Background: Lymph node status is among the most important predictors of recurrence after gastrectomy for gastric adenocarcinoma. Pathologic features predictive of recurrence in patients with node-negative disease are less well established. Methods: Patients who underwent curative resection for gastric adenocarcinoma between 2000 and 2012 from 7 institutions of the US Gastric Cancer Collaborative were analyzed, excluding 30-day mortalities and stage IV disease. Competing risks regression and multivariate Cox regression were used to determine pathologic features associated with time to recurrence and overall survival. Differences in cumulative incidence of recurrence were assessed using the Gray method (for univariate nonparametric analyses) and the Fine and Gray method (for multivariate analyses) and shown as subhazard ratios (SHRs) and adjusted subhazard ratios (aSHRs), respectively. Results: Of 805 patients who met inclusion criteria, 317 (39%) had nodenegative disease, of which 54 (17%) recurred. By 2 and 5 years, 66% and 88% of patients, respectively, experienced recurrence. On multivariate competing risks regression, only T-stage 3 or higher was associated with shorter time to recurrence [aSHR=2.7; 95% confidence interval (CI), 1.5-5.2]. Multivariate Cox regression showed T-stage 3 or higher [hazard ratio (HR)=1.8; 95% CI, 1.2-2.8], lymphovascular invasion (HR=2.2; 95% CI, 1.4-3.4), and signet ring histology (HR=2.1; 95% CI, 1.2-3.6) to be associated with decreased overall survival. Conclusions: Despite absence of lymph node involvement, patients with Tstage 3 or higher have a significantly shorter time to recurrence. These patients may benefit from more aggressive adjuvant therapy and postoperative surveillance regimens.

Original languageEnglish (US)
Pages (from-to)999-1005
Number of pages7
JournalAnnals of Surgery
Volume262
Issue number6
DOIs
StatePublished - 2015

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Stomach Neoplasms
Stomach
Adenocarcinoma
Lymph Nodes
Recurrence
Survival
Confidence Intervals
Gastrectomy
Histology
Multivariate Analysis
Mortality
Incidence

Keywords

  • Competing risks regression
  • Gastric cancer
  • Node-Negative
  • Recurrence
  • Survival

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

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Factors associated with recurrence and survival in lymph node-negative gastric adenocarcinoma : A 7-institution study of the us gastric cancer collaborative. / Jin, Linda X.; Moses, Lindsey E.; Hart Squires, M.; Poultsides, George A.; Votanopoulos, Konstantinos; Weber, Sharon M.; Bloomston, Mark; Pawlik, Timothy M.; Hawkins, William G.; Linehan, David C.; Strasberg, Steven M.; Schmidt, Carl; Worhunsky, David J.; Acher, Alexandra W.; Cardona, Kenneth; Cho, Clifford S.; Kooby, David A.; Levine, Edward; Winslow, Emily R.; Saunders, Neil D.; Spolverato, Gaya; Maithel, Shishir K.; Fields, Ryan C.

In: Annals of Surgery, Vol. 262, No. 6, 2015, p. 999-1005.

Research output: Contribution to journalArticle

Jin, LX, Moses, LE, Hart Squires, M, Poultsides, GA, Votanopoulos, K, Weber, SM, Bloomston, M, Pawlik, TM, Hawkins, WG, Linehan, DC, Strasberg, SM, Schmidt, C, Worhunsky, DJ, Acher, AW, Cardona, K, Cho, CS, Kooby, DA, Levine, E, Winslow, ER, Saunders, ND, Spolverato, G, Maithel, SK & Fields, RC 2015, 'Factors associated with recurrence and survival in lymph node-negative gastric adenocarcinoma: A 7-institution study of the us gastric cancer collaborative', Annals of Surgery, vol. 262, no. 6, pp. 999-1005. https://doi.org/10.1097/SLA.0000000000001084
Jin, Linda X. ; Moses, Lindsey E. ; Hart Squires, M. ; Poultsides, George A. ; Votanopoulos, Konstantinos ; Weber, Sharon M. ; Bloomston, Mark ; Pawlik, Timothy M. ; Hawkins, William G. ; Linehan, David C. ; Strasberg, Steven M. ; Schmidt, Carl ; Worhunsky, David J. ; Acher, Alexandra W. ; Cardona, Kenneth ; Cho, Clifford S. ; Kooby, David A. ; Levine, Edward ; Winslow, Emily R. ; Saunders, Neil D. ; Spolverato, Gaya ; Maithel, Shishir K. ; Fields, Ryan C. / Factors associated with recurrence and survival in lymph node-negative gastric adenocarcinoma : A 7-institution study of the us gastric cancer collaborative. In: Annals of Surgery. 2015 ; Vol. 262, No. 6. pp. 999-1005.
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abstract = "Objectives: To determine pathologic features associated with recurrence and survival in patients with lymph node-negative gastric adenocarcinoma. Study Design: Multi-institutional retrospective analysis. Background: Lymph node status is among the most important predictors of recurrence after gastrectomy for gastric adenocarcinoma. Pathologic features predictive of recurrence in patients with node-negative disease are less well established. Methods: Patients who underwent curative resection for gastric adenocarcinoma between 2000 and 2012 from 7 institutions of the US Gastric Cancer Collaborative were analyzed, excluding 30-day mortalities and stage IV disease. Competing risks regression and multivariate Cox regression were used to determine pathologic features associated with time to recurrence and overall survival. Differences in cumulative incidence of recurrence were assessed using the Gray method (for univariate nonparametric analyses) and the Fine and Gray method (for multivariate analyses) and shown as subhazard ratios (SHRs) and adjusted subhazard ratios (aSHRs), respectively. Results: Of 805 patients who met inclusion criteria, 317 (39{\%}) had nodenegative disease, of which 54 (17{\%}) recurred. By 2 and 5 years, 66{\%} and 88{\%} of patients, respectively, experienced recurrence. On multivariate competing risks regression, only T-stage 3 or higher was associated with shorter time to recurrence [aSHR=2.7; 95{\%} confidence interval (CI), 1.5-5.2]. Multivariate Cox regression showed T-stage 3 or higher [hazard ratio (HR)=1.8; 95{\%} CI, 1.2-2.8], lymphovascular invasion (HR=2.2; 95{\%} CI, 1.4-3.4), and signet ring histology (HR=2.1; 95{\%} CI, 1.2-3.6) to be associated with decreased overall survival. Conclusions: Despite absence of lymph node involvement, patients with Tstage 3 or higher have a significantly shorter time to recurrence. These patients may benefit from more aggressive adjuvant therapy and postoperative surveillance regimens.",
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TY - JOUR

T1 - Factors associated with recurrence and survival in lymph node-negative gastric adenocarcinoma

T2 - A 7-institution study of the us gastric cancer collaborative

AU - Jin, Linda X.

AU - Moses, Lindsey E.

AU - Hart Squires, M.

AU - Poultsides, George A.

AU - Votanopoulos, Konstantinos

AU - Weber, Sharon M.

AU - Bloomston, Mark

AU - Pawlik, Timothy M.

AU - Hawkins, William G.

AU - Linehan, David C.

AU - Strasberg, Steven M.

AU - Schmidt, Carl

AU - Worhunsky, David J.

AU - Acher, Alexandra W.

AU - Cardona, Kenneth

AU - Cho, Clifford S.

AU - Kooby, David A.

AU - Levine, Edward

AU - Winslow, Emily R.

AU - Saunders, Neil D.

AU - Spolverato, Gaya

AU - Maithel, Shishir K.

AU - Fields, Ryan C.

PY - 2015

Y1 - 2015

N2 - Objectives: To determine pathologic features associated with recurrence and survival in patients with lymph node-negative gastric adenocarcinoma. Study Design: Multi-institutional retrospective analysis. Background: Lymph node status is among the most important predictors of recurrence after gastrectomy for gastric adenocarcinoma. Pathologic features predictive of recurrence in patients with node-negative disease are less well established. Methods: Patients who underwent curative resection for gastric adenocarcinoma between 2000 and 2012 from 7 institutions of the US Gastric Cancer Collaborative were analyzed, excluding 30-day mortalities and stage IV disease. Competing risks regression and multivariate Cox regression were used to determine pathologic features associated with time to recurrence and overall survival. Differences in cumulative incidence of recurrence were assessed using the Gray method (for univariate nonparametric analyses) and the Fine and Gray method (for multivariate analyses) and shown as subhazard ratios (SHRs) and adjusted subhazard ratios (aSHRs), respectively. Results: Of 805 patients who met inclusion criteria, 317 (39%) had nodenegative disease, of which 54 (17%) recurred. By 2 and 5 years, 66% and 88% of patients, respectively, experienced recurrence. On multivariate competing risks regression, only T-stage 3 or higher was associated with shorter time to recurrence [aSHR=2.7; 95% confidence interval (CI), 1.5-5.2]. Multivariate Cox regression showed T-stage 3 or higher [hazard ratio (HR)=1.8; 95% CI, 1.2-2.8], lymphovascular invasion (HR=2.2; 95% CI, 1.4-3.4), and signet ring histology (HR=2.1; 95% CI, 1.2-3.6) to be associated with decreased overall survival. Conclusions: Despite absence of lymph node involvement, patients with Tstage 3 or higher have a significantly shorter time to recurrence. These patients may benefit from more aggressive adjuvant therapy and postoperative surveillance regimens.

AB - Objectives: To determine pathologic features associated with recurrence and survival in patients with lymph node-negative gastric adenocarcinoma. Study Design: Multi-institutional retrospective analysis. Background: Lymph node status is among the most important predictors of recurrence after gastrectomy for gastric adenocarcinoma. Pathologic features predictive of recurrence in patients with node-negative disease are less well established. Methods: Patients who underwent curative resection for gastric adenocarcinoma between 2000 and 2012 from 7 institutions of the US Gastric Cancer Collaborative were analyzed, excluding 30-day mortalities and stage IV disease. Competing risks regression and multivariate Cox regression were used to determine pathologic features associated with time to recurrence and overall survival. Differences in cumulative incidence of recurrence were assessed using the Gray method (for univariate nonparametric analyses) and the Fine and Gray method (for multivariate analyses) and shown as subhazard ratios (SHRs) and adjusted subhazard ratios (aSHRs), respectively. Results: Of 805 patients who met inclusion criteria, 317 (39%) had nodenegative disease, of which 54 (17%) recurred. By 2 and 5 years, 66% and 88% of patients, respectively, experienced recurrence. On multivariate competing risks regression, only T-stage 3 or higher was associated with shorter time to recurrence [aSHR=2.7; 95% confidence interval (CI), 1.5-5.2]. Multivariate Cox regression showed T-stage 3 or higher [hazard ratio (HR)=1.8; 95% CI, 1.2-2.8], lymphovascular invasion (HR=2.2; 95% CI, 1.4-3.4), and signet ring histology (HR=2.1; 95% CI, 1.2-3.6) to be associated with decreased overall survival. Conclusions: Despite absence of lymph node involvement, patients with Tstage 3 or higher have a significantly shorter time to recurrence. These patients may benefit from more aggressive adjuvant therapy and postoperative surveillance regimens.

KW - Competing risks regression

KW - Gastric cancer

KW - Node-Negative

KW - Recurrence

KW - Survival

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