Rates and patterns of recurrence after curative intent resection for gastric cancer: A United States multi-institutional analysis

Gaya Spolverato, Aslam Ejaz, Yuhree Kim, Malcolm H. Squires, George A. Poultsides, Ryan C. Fields, Carl Schmidt, Sharon M. Weber, Konstantinos Votanopoulos, Shishir K. Maithel, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

Background: Reports on recurrence and outcomes of US patients with gastric cancer are scarce. The aim of this study was to determine incidence and pattern of recurrence after curative intent surgery for gastric cancer.

Study Design: Using the multi-institutional US Gastric Cancer Collaborative database, we identified 817 patients undergoing curative intent resection for gastric cancer between 2000 and 2012. Patterns and rates of recurrence along with associated risk factors were identified using adjusted regression analysis. Recurrences were classified as locoregional, peritoneal, or hematogenous.

Results: Median patient age was 65.8 years (interquartile range [IQR] 56.4, 74.7); the majority of patients were male (n = 462, 56.6%) and white (n = 511, 62.5%). At the time of surgery, the majority of patients underwent a partial gastrectomy (n = 481, 59.2%) with a complete R0 resection achieved in 91.6% (n = 748) of patients. At the time of last follow-up, 244 (29.9%) of 817 patients developed a recurrence; 163 (66.8%) patients had recurrence at only a single site; the remaining 81 (33.2%) had multiple sites of initial recurrence. Among patients who recurred at a single site, recurrence was most common at a distant location and included hematogenous (n = 57, 23.4%) or peritoneal (n = 47, 19.3%) only metastasis. Tumors at the gastroesophageal junction (odds ratio [OR] 3.18, 95% CI 1.08 to 9.40; p = 0.04) were associated with higher risk of locoregional recurrence, while the presence of multiple lesions (OR 10.82, 95% CI 3.56 to 32.85; p <0.001) remained associated with an increased risk of distant hematogenous recurrence after adjusted analysis. Recurrence was associated with worse survival, with a median recurrence-free survival of 10.8 months (IQR 8.9, 12.8) among those who experienced a recurrence.

Conclusions: Nearly one-third of patients experienced recurrence after gastric cancer surgery. The most common site of recurrence was distant.

Original languageEnglish (US)
Pages (from-to)664-675
Number of pages12
JournalJournal of the American College of Surgeons
Volume219
Issue number4
DOIs
StatePublished - Oct 1 2014

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Stomach Neoplasms
Recurrence
Odds Ratio
Esophagogastric Junction
Survival
Gastrectomy
Regression Analysis
Databases
Neoplasm Metastasis

ASJC Scopus subject areas

  • Surgery

Cite this

Rates and patterns of recurrence after curative intent resection for gastric cancer : A United States multi-institutional analysis. / Spolverato, Gaya; Ejaz, Aslam; Kim, Yuhree; Squires, Malcolm H.; Poultsides, George A.; Fields, Ryan C.; Schmidt, Carl; Weber, Sharon M.; Votanopoulos, Konstantinos; Maithel, Shishir K.; Pawlik, Timothy M.

In: Journal of the American College of Surgeons, Vol. 219, No. 4, 01.10.2014, p. 664-675.

Research output: Contribution to journalArticle

Spolverato, G, Ejaz, A, Kim, Y, Squires, MH, Poultsides, GA, Fields, RC, Schmidt, C, Weber, SM, Votanopoulos, K, Maithel, SK & Pawlik, TM 2014, 'Rates and patterns of recurrence after curative intent resection for gastric cancer: A United States multi-institutional analysis', Journal of the American College of Surgeons, vol. 219, no. 4, pp. 664-675. https://doi.org/10.1016/j.jamcollsurg.2014.03.062
Spolverato, Gaya ; Ejaz, Aslam ; Kim, Yuhree ; Squires, Malcolm H. ; Poultsides, George A. ; Fields, Ryan C. ; Schmidt, Carl ; Weber, Sharon M. ; Votanopoulos, Konstantinos ; Maithel, Shishir K. ; Pawlik, Timothy M. / Rates and patterns of recurrence after curative intent resection for gastric cancer : A United States multi-institutional analysis. In: Journal of the American College of Surgeons. 2014 ; Vol. 219, No. 4. pp. 664-675.
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abstract = "Background: Reports on recurrence and outcomes of US patients with gastric cancer are scarce. The aim of this study was to determine incidence and pattern of recurrence after curative intent surgery for gastric cancer.Study Design: Using the multi-institutional US Gastric Cancer Collaborative database, we identified 817 patients undergoing curative intent resection for gastric cancer between 2000 and 2012. Patterns and rates of recurrence along with associated risk factors were identified using adjusted regression analysis. Recurrences were classified as locoregional, peritoneal, or hematogenous.Results: Median patient age was 65.8 years (interquartile range [IQR] 56.4, 74.7); the majority of patients were male (n = 462, 56.6{\%}) and white (n = 511, 62.5{\%}). At the time of surgery, the majority of patients underwent a partial gastrectomy (n = 481, 59.2{\%}) with a complete R0 resection achieved in 91.6{\%} (n = 748) of patients. At the time of last follow-up, 244 (29.9{\%}) of 817 patients developed a recurrence; 163 (66.8{\%}) patients had recurrence at only a single site; the remaining 81 (33.2{\%}) had multiple sites of initial recurrence. Among patients who recurred at a single site, recurrence was most common at a distant location and included hematogenous (n = 57, 23.4{\%}) or peritoneal (n = 47, 19.3{\%}) only metastasis. Tumors at the gastroesophageal junction (odds ratio [OR] 3.18, 95{\%} CI 1.08 to 9.40; p = 0.04) were associated with higher risk of locoregional recurrence, while the presence of multiple lesions (OR 10.82, 95{\%} CI 3.56 to 32.85; p <0.001) remained associated with an increased risk of distant hematogenous recurrence after adjusted analysis. Recurrence was associated with worse survival, with a median recurrence-free survival of 10.8 months (IQR 8.9, 12.8) among those who experienced a recurrence.Conclusions: Nearly one-third of patients experienced recurrence after gastric cancer surgery. The most common site of recurrence was distant.",
author = "Gaya Spolverato and Aslam Ejaz and Yuhree Kim and Squires, {Malcolm H.} and Poultsides, {George A.} and Fields, {Ryan C.} and Carl Schmidt and Weber, {Sharon M.} and Konstantinos Votanopoulos and Maithel, {Shishir K.} and Pawlik, {Timothy M.}",
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T1 - Rates and patterns of recurrence after curative intent resection for gastric cancer

T2 - A United States multi-institutional analysis

AU - Spolverato, Gaya

AU - Ejaz, Aslam

AU - Kim, Yuhree

AU - Squires, Malcolm H.

AU - Poultsides, George A.

AU - Fields, Ryan C.

AU - Schmidt, Carl

AU - Weber, Sharon M.

AU - Votanopoulos, Konstantinos

AU - Maithel, Shishir K.

AU - Pawlik, Timothy M.

PY - 2014/10/1

Y1 - 2014/10/1

N2 - Background: Reports on recurrence and outcomes of US patients with gastric cancer are scarce. The aim of this study was to determine incidence and pattern of recurrence after curative intent surgery for gastric cancer.Study Design: Using the multi-institutional US Gastric Cancer Collaborative database, we identified 817 patients undergoing curative intent resection for gastric cancer between 2000 and 2012. Patterns and rates of recurrence along with associated risk factors were identified using adjusted regression analysis. Recurrences were classified as locoregional, peritoneal, or hematogenous.Results: Median patient age was 65.8 years (interquartile range [IQR] 56.4, 74.7); the majority of patients were male (n = 462, 56.6%) and white (n = 511, 62.5%). At the time of surgery, the majority of patients underwent a partial gastrectomy (n = 481, 59.2%) with a complete R0 resection achieved in 91.6% (n = 748) of patients. At the time of last follow-up, 244 (29.9%) of 817 patients developed a recurrence; 163 (66.8%) patients had recurrence at only a single site; the remaining 81 (33.2%) had multiple sites of initial recurrence. Among patients who recurred at a single site, recurrence was most common at a distant location and included hematogenous (n = 57, 23.4%) or peritoneal (n = 47, 19.3%) only metastasis. Tumors at the gastroesophageal junction (odds ratio [OR] 3.18, 95% CI 1.08 to 9.40; p = 0.04) were associated with higher risk of locoregional recurrence, while the presence of multiple lesions (OR 10.82, 95% CI 3.56 to 32.85; p <0.001) remained associated with an increased risk of distant hematogenous recurrence after adjusted analysis. Recurrence was associated with worse survival, with a median recurrence-free survival of 10.8 months (IQR 8.9, 12.8) among those who experienced a recurrence.Conclusions: Nearly one-third of patients experienced recurrence after gastric cancer surgery. The most common site of recurrence was distant.

AB - Background: Reports on recurrence and outcomes of US patients with gastric cancer are scarce. The aim of this study was to determine incidence and pattern of recurrence after curative intent surgery for gastric cancer.Study Design: Using the multi-institutional US Gastric Cancer Collaborative database, we identified 817 patients undergoing curative intent resection for gastric cancer between 2000 and 2012. Patterns and rates of recurrence along with associated risk factors were identified using adjusted regression analysis. Recurrences were classified as locoregional, peritoneal, or hematogenous.Results: Median patient age was 65.8 years (interquartile range [IQR] 56.4, 74.7); the majority of patients were male (n = 462, 56.6%) and white (n = 511, 62.5%). At the time of surgery, the majority of patients underwent a partial gastrectomy (n = 481, 59.2%) with a complete R0 resection achieved in 91.6% (n = 748) of patients. At the time of last follow-up, 244 (29.9%) of 817 patients developed a recurrence; 163 (66.8%) patients had recurrence at only a single site; the remaining 81 (33.2%) had multiple sites of initial recurrence. Among patients who recurred at a single site, recurrence was most common at a distant location and included hematogenous (n = 57, 23.4%) or peritoneal (n = 47, 19.3%) only metastasis. Tumors at the gastroesophageal junction (odds ratio [OR] 3.18, 95% CI 1.08 to 9.40; p = 0.04) were associated with higher risk of locoregional recurrence, while the presence of multiple lesions (OR 10.82, 95% CI 3.56 to 32.85; p <0.001) remained associated with an increased risk of distant hematogenous recurrence after adjusted analysis. Recurrence was associated with worse survival, with a median recurrence-free survival of 10.8 months (IQR 8.9, 12.8) among those who experienced a recurrence.Conclusions: Nearly one-third of patients experienced recurrence after gastric cancer surgery. The most common site of recurrence was distant.

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