{"title":"Early and late recurrences in lymph node-negative gastric cancer: a retrospective cohort study.","authors":"Jian-Wei Sun, Dao-Li Liu, Jia-Xian Chen, Li-Zhen Lin, Lv-Ping Zhuang, Xian-Hai Hou","doi":"10.5144/0256-4947.2021.336","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Predictors of recurrence in patients with lymph node-negative gastric cancer (GC) who have undergone curative resection have been widely investigated, but not the effects of predictors on timing of recurrence.</p><p><strong>Objective: </strong>Determine the factors associated with early and late recurrence in patients with node-negative GC.</p><p><strong>Design: </strong>Retrospective cohort.</p><p><strong>Setting: </strong>Academic tertiary care center.</p><p><strong>Patients and methods: </strong>The study included patients with node-negative GC after curative resection between 2008 and 2018 at two institutions. Early and late recurrences were determined using a minimum <i>P</i> value approach to evaluate the optimal cutoff for recurrence-free survival (RFS). A competing risk model and landmark analysis were used to analyze factors associated with early and late recurrences.</p><p><strong>Main outcome measures: </strong>Recurrence-free survival and factors associated with survival.</p><p><strong>Sample size: </strong>606.</p><p><strong>Results: </strong>After a median follow-up of 70 months, 50 (8.3%) patients experienced recurrent disease. The optimal length of RFS for distinguishing between early (n=26) and late recurrence (n=24) was 24 months (<i>P</i>=.0013). The median RFS in the early and late recurrence groups was 11 and 32 months, respectively. Diffuse tumors (hazard ratio 3.358, <i>P</i>=.014), advanced T stage (HR 8.804, <i>P</i>=.003), perineural invasion (HR 10.955, <i>P</i><.001), and anemia (HR 2.351, <i>P</i>=.018) were independent predictors of early recurrence. Mixed tumor location (HR 5.586, <i>P</i>=.002), advanced T stage (HR 5.066, <i>P</i><.001), lymphovascular invasion (HR 5.902, <i>P</i><.001), and elevated CA19-9 levels (HR 5.227, <i>P</i><.001) were independent predictors of late recurrence. Similar results were obtained in the landmark analysis.</p><p><strong>Conclusions: </strong>Individualized therapeutic and follow-up strategies should be considered in future studies because of distinct patterns in predictors of early and late recurrence.</p><p><strong>Limitations: </strong>Retrospective design, small sample size.</p><p><strong>Conflict of interest: </strong>None.</p>","PeriodicalId":8016,"journal":{"name":"Annals of Saudi Medicine","volume":"41 6","pages":"336-349"},"PeriodicalIF":1.5000,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1d/62/0256-4947.2021.336.PMC8650598.pdf","citationCount":"2","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Saudi Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5144/0256-4947.2021.336","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2021/12/2 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 2
Abstract
Background: Predictors of recurrence in patients with lymph node-negative gastric cancer (GC) who have undergone curative resection have been widely investigated, but not the effects of predictors on timing of recurrence.
Objective: Determine the factors associated with early and late recurrence in patients with node-negative GC.
Design: Retrospective cohort.
Setting: Academic tertiary care center.
Patients and methods: The study included patients with node-negative GC after curative resection between 2008 and 2018 at two institutions. Early and late recurrences were determined using a minimum P value approach to evaluate the optimal cutoff for recurrence-free survival (RFS). A competing risk model and landmark analysis were used to analyze factors associated with early and late recurrences.
Main outcome measures: Recurrence-free survival and factors associated with survival.
Sample size: 606.
Results: After a median follow-up of 70 months, 50 (8.3%) patients experienced recurrent disease. The optimal length of RFS for distinguishing between early (n=26) and late recurrence (n=24) was 24 months (P=.0013). The median RFS in the early and late recurrence groups was 11 and 32 months, respectively. Diffuse tumors (hazard ratio 3.358, P=.014), advanced T stage (HR 8.804, P=.003), perineural invasion (HR 10.955, P<.001), and anemia (HR 2.351, P=.018) were independent predictors of early recurrence. Mixed tumor location (HR 5.586, P=.002), advanced T stage (HR 5.066, P<.001), lymphovascular invasion (HR 5.902, P<.001), and elevated CA19-9 levels (HR 5.227, P<.001) were independent predictors of late recurrence. Similar results were obtained in the landmark analysis.
Conclusions: Individualized therapeutic and follow-up strategies should be considered in future studies because of distinct patterns in predictors of early and late recurrence.
Limitations: Retrospective design, small sample size.
期刊介绍：
The Annals of Saudi Medicine (ASM) is published bimonthly by King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. We publish scientific reports of clinical interest in English. All submissions are subject to peer review by the editorial board and by reviewers in appropriate specialties. The journal will consider for publication manuscripts from any part of the world, but particularly reports that would be of interest to readers in the Middle East or other parts of Asia and Africa. Please go to the Author Resource Center for additional information.
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