TY - JOUR
T1 - Recurrence after preoperative chemotherapy and surgery for gastric adenocarcinoma
T2 - a multicenter study
AU - Mokadem, I.
AU - Dijksterhuis, W. P. M.
AU - van Putten, M.
AU - Heuthorst, L.
AU - de Vos-Geelen, J. M.
AU - Mohammad, N. Haj
AU - Nieuwenhuijzen, G. A. P.
AU - van Laarhoven, H. W. M.
AU - Verhoeven, R. H. A.
N1 - Funding Information:
The authors thank the Netherlands Cancer Registry and registration personnel for their dedicated data collection.
Publisher Copyright:
© 2019, The Author(s).
PY - 2019/11
Y1 - 2019/11
N2 - Background In most western European countries perioperative chemotherapy is a part of standard curative treatment for gastric cancer. Nevertheless, recurrence rates remain high after multimodality treatment. This study examines patterns of recurrence in patients receiving perioperative chemotherapy with surgery for gastric cancer in a real-world setting. Methods All patients diagnosed with gastric adenocarcinoma between 2010 and 2015 who underwent at least preoperative chemotherapy and a gastrectomy with curative intent (cT1N+/cT2-4a,X; any cN; cM0) in 18 Dutch hospitals were selected from the Netherlands Cancer Registry. Additional data on chemotherapy and recurrence were collected from medical records. Rates, patterns, and timing of recurrence were examined. Multivariable Cox proportional hazard analyses were used to determine prognostic factors for recurrence. Results 408 patients were identified. After a median follow-up of 27.8 months, 36.8% of the gastric cancer patients had a recurrence of which the majority (88.8%) had distant metastasis. The 1-year recurrence-free survival was 71.8%. The risk of recurrence was higher in patients with an ypN+ stage (HR 4.92, 95% CI 3.35-7.24), partial or no tumor regression (HR 2.63, 95% CI 1.22-5.64), 3 instead of >= 6 chemotherapy cycles (HR 3.04, 95% CI 1.99-4.63), R1 resection (HR 1.52, 95% CI 1.02-2.26), and <15 resected lymph nodes (HR 1.64, 95% CI 1.14-2.37). Conclusion A considerable amount of gastric cancer patients who were treated with curative intent developed a recurrence despite surgery and perioperative treatment. The majority developed distant metastases, therefore, multimodality treatment approaches should be focused on the prevention of distant rather than locoregional recurrences to improve survival.
AB - Background In most western European countries perioperative chemotherapy is a part of standard curative treatment for gastric cancer. Nevertheless, recurrence rates remain high after multimodality treatment. This study examines patterns of recurrence in patients receiving perioperative chemotherapy with surgery for gastric cancer in a real-world setting. Methods All patients diagnosed with gastric adenocarcinoma between 2010 and 2015 who underwent at least preoperative chemotherapy and a gastrectomy with curative intent (cT1N+/cT2-4a,X; any cN; cM0) in 18 Dutch hospitals were selected from the Netherlands Cancer Registry. Additional data on chemotherapy and recurrence were collected from medical records. Rates, patterns, and timing of recurrence were examined. Multivariable Cox proportional hazard analyses were used to determine prognostic factors for recurrence. Results 408 patients were identified. After a median follow-up of 27.8 months, 36.8% of the gastric cancer patients had a recurrence of which the majority (88.8%) had distant metastasis. The 1-year recurrence-free survival was 71.8%. The risk of recurrence was higher in patients with an ypN+ stage (HR 4.92, 95% CI 3.35-7.24), partial or no tumor regression (HR 2.63, 95% CI 1.22-5.64), 3 instead of >= 6 chemotherapy cycles (HR 3.04, 95% CI 1.99-4.63), R1 resection (HR 1.52, 95% CI 1.02-2.26), and <15 resected lymph nodes (HR 1.64, 95% CI 1.14-2.37). Conclusion A considerable amount of gastric cancer patients who were treated with curative intent developed a recurrence despite surgery and perioperative treatment. The majority developed distant metastases, therefore, multimodality treatment approaches should be focused on the prevention of distant rather than locoregional recurrences to improve survival.
KW - Gastric neoplasms
KW - Perioperative care
KW - Drug therapy
KW - Neoadjuvant therapy
KW - Adjuvant chemotherapy
KW - Recurrence
KW - PERIOPERATIVE CHEMOTHERAPY
KW - NEOADJUVANT CHEMOTHERAPY
KW - CURATIVE RESECTION
KW - TUMOR-REGRESSION
KW - CANCER
KW - PATTERNS
KW - CHEMORADIOTHERAPY
U2 - 10.1007/s10120-019-00956-6
DO - 10.1007/s10120-019-00956-6
M3 - Article
C2 - 30949777
SN - 1436-3291
VL - 22
SP - 1263
EP - 1273
JO - Gastric Cancer
JF - Gastric Cancer
IS - 6
ER -