Year 2019 / Volume 111 / Number 7
Original
The predictive factors of gastric cancer recurrence after the completion of adjuvant chemotherapy in advanced gastric cancer

537-542

DOI: 10.17235/reed.2019.6041/2018

Yeon-Ji Kim, Woo Chul Chung, Gun Jung Youn, Kyong-Hwa Jun, Hyung-Min Chin,

Abstract
Objective: the administration of adjuvant chemotherapy after a curative resection is accepted as the standard treatment to improve the prognosis of advanced gastric cancer. Nevertheless, the prognosis of recurrence-related gastric cancer is still not clinically satisfactory. We aimed to assess the therapeutic yield of a radical gastrectomy with D2 lymphadenectomy (R0 resection) and the completion of adjuvant chemotherapy. The predictive risk factors for recurrence were also assessed. Methods: a retrospective cohort study was designed with patients diagnosed with advanced gastric cancer. Patients with an R0 resection who had completed adjuvant chemotherapy were included in the study. Results: data from 130 patients who had undergone an R0 resection and had completed six cycles of adjuvant chemotherapy were analyzed. The chemotherapy compliance rate was 63.11% and the overall recurrence rate was 36.9%. The lymph node ratio (LNR), which was defined as the number of metastatic lymph nodes divided by the retrieved lymph nodes, was a significant risk factor in the lymph node-positive group (p < 0.01). This parameter had a relatively high sensitivity to predict recurrence compared with the 7th and 8th edition of the AJCC staging system, with an area under the curve of 0.735 (95% confidence interval: 0.639-0.832). Baseline CA19-9 level was a risk factor in the lymph node-negative group (p = 0.01). Conclusions: LNR and baseline CA19-9 levels, as simple markers, had strong predictive values for the recurrence of advanced gastric cancer. With regard to recurrence, more potent adjuvant therapy should be considered in high-risk patients.
Share Button
New comment
Comments
No comments for this article
References
1. Torre LA, Siegel RL, Ward EM, et al. Global Cancer Incidence and Mortality Rates and Trends--An Update. Cancer Epidemiol Biomarkers Prev 2016;25:16-27.
2. Oh CM, Won YJ, Jung KW, et al. Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2013. Cancer Res Treat 2016;48:436-450.
3. Rahman R, Asombang AW, Ibdah JA. Characteristics of gastric cancer in Asia. World J Gastroenterol 2014;20:4483-4490.
4. Songun I, Putter H, Kranenbarg EM, et al. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol 2010;11:439-449.
5. Roviello F, Marrelli D, de Manzoni G, et al. Prospective study of peritoneal recurrence after curative surgery for gastric cancer. Br J Surg 2003;90:1113-1119.
6. Yoo CH, Noh SH, Shin DW, et al. Recurrence following curative resection for gastric carcinoma. Br J Surg 2000;87:236-242.
7. Shin CH, Lee WY, Hong SW, et al. Characteristics of gastric cancer recurrence five or more years after curative gastrectomy. Chin J Cancer Res 2016;28:503-510.
8. Deng J, Liang H, Sun D, et al. Prognosis of gastric cancer patients with node-negative metastasis following curative resection: outcomes of the survival and recurrence. Can J Gastroenterol 2008;22:835-839.
9. Lee EW, Lee WY, Koo HS. Prognostic Factors for Node-Negative Advanced Gastric Cancer after Curative Gastrectomy. J Gastric Cancer 2016;16:161-166.
10. Sakuramoto S, Sasako M, Yamaguchi T, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 2007;357:1810-1820.
11. Bang YJ, Kim YW, Yang HK, et al. Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial. Lancet 2012;379:315-321.
12. Lee JH, Kim JG, Jung HK, et al. Clinical practice guidelines for gastric cancer in Korea: an evidence-based approach. J Gastric Cancer 2014;14:87-104.
13. Mari E, Floriani I, Tinazzi A, et al. Efficacy of adjuvant chemotherapy after curative resection for gastric cancer: a meta-analysis of published randomised trials. A study of the GISCAD (Gruppo Italiano per lo Studio dei Carcinomi dell'Apparato Digerente). Ann Oncol 2000;11:837-843.
14. Paoletti X, Oba K, Burzykowski T, et al. Benefit of adjuvant chemotherapy for resectable gastric cancer: a meta-analysis. JAMA 2010;303:1729-1737.
15. Japanese Gastric Cancer A. Japanese Classification of Gastric Carcinoma - 2nd English Edition. Gastric Cancer 1998;1:10-24.
16. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 2010;17:1471-1474.
17. Amin MB, Edge S, Greene F, et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin 2017;67:93-99.
18. Marchet A, Mocellin S, Ambrosi A, et al. The ratio between metastatic and examined lymph nodes (N ratio) is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy: results from an Italian multicentric study in 1853 patients. Ann Surg 2007;245:543-552.
19. Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 2006;355:11-20.
20. Janunger KG, Hafstrom L, Nygren P, et al. A systematic overview of chemotherapy effects in gastric cancer. Acta Oncol 2001;40:309-326.
21. Chen S, Rao H, Liu J, et al. Lymph nodes ratio based nomogram predicts survival of resectable gastric cancer regardless of the number of examined lymph nodes. Oncotarget 2017;8:45585-45596.
22. Bouliaris K, Rachiotis G, Diamantis A, et al. Lymph node ratio as a prognostic factor in gastric cancer patients following D1 resection. Comparison with the current TNM staging system. Eur J Surg Oncol 2017;43:1350-1356.
23. Nakagawa M, Choi YY, An JY, et al. Staging for Remnant Gastric Cancer: The Metastatic Lymph Node Ratio vs. the UICC 7th Edition System. Ann Surg Oncol 2016;23:4322-4331.
24. Sianesi M, Bezer L, Del Rio P, et al. The node ratio as prognostic factor after curative resection for gastric cancer. J Gastrointest Surg 2010;14:614-619.
25. Alatengbaolide, Lin D, Li Y, et al. Lymph node ratio is an independent prognostic factor in gastric cancer after curative resection (R0) regardless of the examined number of lymph nodes. Am J Clin Oncol 2013;36:325-330.
26. Bunt AM, Hermans J, Smit VT, et al. Surgical/pathologic-stage migration confounds comparisons of gastric cancer survival rates between Japan and Western countries. J Clin Oncol 1995;13:19-25.
27. Kim JH, Park JM, Jung CW, et al. The significances of lymph node micrometastasis and its correlation with E-cadherin expression in pT1-T3N0 gastric adenocarcinoma. J Surg Oncol 2008;97:125-30.
28. Zhou Y, Cui JG, Huang F, et al. Prognostic factors for Survival in node-negative gastric cancer patients who underwent curative resection. Scand J Surg 2017;106:235-40.
29. Ychou M, Duffour J, Kramar A, et al. Clinical significance and prognostic value of CA72-4 compared with CEA and CA19-9 in patients with gastric cancer. Dis Markers 2000;16:105-10.
30. Duraker N, Celik AN. The prognostic significance of preoperative serum CA 19-9 in patients with resectable gastric carcinoma: comparison with CEA. J Surg Oncol 2001;76:266-71.
31. Huang ZB, Zhou X, Xu J, et al. Prognostic value of preoperative serum tumor markers in gastric cancer. World J Clin Oncol 2014;5:170-6.
32. Marrelli D, Roviello F, De Stefano A, et al. Prognostic significance of CEA, CA 19-9 and CA 72-4 preoperative serum levels in gastric carcinoma. Oncology 1999;57:55-62.
33. Ucar E, Semerci E, Ustun H, et al. Prognostic value of preoperative CEA, CA 19-9, CA 72-4, and AFP levels in gastric cancer. Adv Ther 2008;25:1075-84.
34. Hamazoe R, Maeta M, Matsui T, et al. CA72-4 compared with carcinoembryonic antigen as a tumour marker for gastric cancer. Eur J Cancer 1992;28a:1351-4.
35. Nakane Y, Okamura S, Akehira K, et al. Correlation of preoperative carcinoembryonic antigen levels and prognosis of gastric cancer patients. Cancer 1994;73:2703-8.
36. Safi F, Kuhns V, Beger HG. Comparison of CA 72-4, CA 19-9 and CEA in the diagnosis and monitoring of gastric cancer. Int J Biol Markers 1995;10:100-6.
37. Ishigami S, Natsugoe S, Nakashima H, et al. Biological aggressiveness of alpha-fetoprotein (AFP)-positive gastric cancer. Hepatogastroenterology 2006;53:338-41.
38. Inoue M, Sano T, Kuchiba A, et al. Long-term results of gastrectomy for alpha-fetoprotein-producing gastric cancer. Br J Surg 2010;97:1056-61.
39. Kodera Y, Yamamura Y, Torii A, et al. The prognostic value of preoperative serum levels of CEA and CA19-9 in patients with gastric cancer. Am J Gastroenterol 1996;91:49-53.
40. Choi AR, Park JC, Kim JH, et al. High level of preoperative carbohydrate antigen 19-9 is a poor survival predictor in gastric cancer. World J Gastroenterol 2013;19:5302-8.
Related articles

Letter

Sepsis due to phlegmonous gastritis in a cancer patient

DOI: 10.17235/reed.2022.9009/2022

Digestive Diseases Image

Gastroduodenal Burkitt’s lymphoma: a rare cause of epigastric pain and diarrhea

DOI: 10.17235/reed.2021.8150/2021

Letter to the Editor

Utility of neoadjuvant therapy in rectal GIST

DOI: 10.17235/reed.2017.4751/2016

Citation tools
Kim Y, Chung W, Youn G, Jun K, Chin H. The predictive factors of gastric cancer recurrence after the completion of adjuvant chemotherapy in advanced gastric cancer. 6041/2018


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 994 visits.
This article has been downloaded 150 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 12/11/2018

Accepted: 28/01/2019

Online First: 19/06/2019

Published: 04/07/2019

Article revision time: 76 days

Article Online First time: 219 days

Article editing time: 234 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology