Patterns of Recurrence After D2 Radical Surgery for Gastric Cancer: Implications for Postoperative Radiation Therapy.

IF 3.4 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology Pub Date : 2025-03-19 DOI:10.1016/j.prro.2025.03.005

Wenheng Jiang, Haohua Wang, Xiang Zhang, Xue Dou, Kunli Zhu, Lei Xu, Yong Huang, Jinming Yu, Jinbo Yue

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引用次数: 0

Abstract

Purpose: We evaluated the role of adjuvant radiation therapy after D2 lymphadenectomy for gastric cancer (GC), identified patients most likely to benefit from postoperative radiation therapy, and defined the optimal target volume for adjuvant radiation therapy by analyzing recurrence patterns.

Methods and materials: We retrospectively analyzed 1169 patients with stage I to III GC who underwent D2 surgery, of whom 225 experienced recurrence. Both overall and regional recurrences were examined, with regional recurrence patterns categorized by tumor site. Particular emphasis was placed on the vertical distribution of recurrences in lymph nodes at station no. 16. Risk factors for locoregional failure (LRF) were identified by using multivariate logistic regression. A predictive nomogram for LRF was developed and validated by using discrimination (area under the curve of a receiver operating characteristic curve) and calibration (calibration curve with bootstrap resampling).

Results: The predominant pattern of single-site recurrence was peritoneal failure (29.8%), followed by distant metastasis (23.1%) and locoregional failure (20.0%). High-risk lymph node stations for regional recurrence (>10%) included nos. 7, 8, 9, 11p, 12, 13, 16a, and 16b. Although regional recurrence patterns varied by tumor location, station no. 16 consistently demonstrated the highest recurrence rate. Recurrent lymph nodes at station no. 16 exhibited a normal distribution, with about 90% estimated as being located between 6.1 cm below and 5.0 cm above the lower edge of the left renal vein. Multivariate analysis identified pathologic T category (3-4 vs 1-2) and lymph node ratio (>25% vs ≤25%) as independent risk factors for LRF. A predictive nomogram incorporating these factors was developed that achieved an area under the curve of 0.79, indicating good discrimination ability.

Conclusions: This study of recurrence patterns and risk factors for LRF in patients with GC after D2 lymphadenectomy suggests a subpopulation who may benefit from adjuvant radiation therapy and offers insights for target volume definition.

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胃癌 D2 根治术后的复发模式：术后放疗的意义

目的：评价胃癌D2淋巴结切除术后辅助放疗的作用，确定术后最可能受益于放疗的患者，并通过分析复发模式确定辅助放疗的最佳靶体积。方法：回顾性分析1169例行D2手术的I-III期胃癌患者，其中225例复发。检查整体和局部复发，并根据肿瘤部位分类区域复发模式。特别强调的是淋巴结复发的垂直分布。16. 采用多因素logistic回归分析确定局部复发的危险因素。通过区分（接收机工作特性曲线下面积[AUC]）和校准（带自举重采样的校准曲线），建立并验证了LRF的预测模态图。结果：单部位复发以腹膜功能衰竭为主（29.8%），其次为远处转移（23.1%）和局部功能衰竭（20.0%）。7、8、9、11p、12、13、16a、16b为区域复发高危淋巴结站（bbb10 %）。虽然区域复发模式因肿瘤部位而异，但肿瘤的复发部位不相同。16例复发率最高。第1站淋巴结复发。16例呈正态分布，估计约90%位于左肾静脉下缘以下6.1 cm至5.0 cm之间。多因素分析发现病理T分类（3-4 vs. 1-2）和淋巴结比例（bb0 25% vs.≤25%）是LRF的独立危险因素。结合这些因素建立了一个预测nomogram， AUC为0.79，表明有很好的判别能力。结论：这项关于D2淋巴结切除术后胃癌患者LRF复发模式和危险因素的研究表明，这一亚群可能受益于辅助放疗，并为靶体积的定义提供了新的见解。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Practical Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

5.20

自引率

6.10%

发文量

177

审稿时长

34 days

期刊介绍： The overarching mission of Practical Radiation Oncology is to improve the quality of radiation oncology practice. PRO''s purpose is to document the state of current practice, providing background for those in training and continuing education for practitioners, through discussion and illustration of new techniques, evaluation of current practices, and publication of case reports. PRO strives to provide its readers content that emphasizes knowledge "with a purpose." The content of PRO includes: Original articles focusing on patient safety, quality measurement, or quality improvement initiatives Original articles focusing on imaging, contouring, target delineation, simulation, treatment planning, immobilization, organ motion, and other practical issues ASTRO guidelines, position papers, and consensus statements Essays that highlight enriching personal experiences in caring for cancer patients and their families.