Clinicopathological characteristics and prognosis of gastric remnant cancer / 肿瘤

ABSTRACT

Objective: To explore the clinicopathological characteristics of gastric remnant cancer (GRC) and identify its prognostic factors. Methods: From January 2003 to December 2012, 85 patients with gastric remnant cancer were treated in Renji Hospital, School of Medicine, Shanghai Jiao Tong University. The medical records of 58 patients who underwent surgical resection were retrospectively analyzed. Results: The patients with GRC accounted for 1.5% of the patients with gastric cancer during the same period. GRC was likely to develop in males, and the ratio of males to females was 4.31. The median age was 70 years old. As compared to patients with previous gastric cancer, Billroth II reconstruction was more common in patients with previous peptic ulcer (73.8% vs 37.5%; P = 0.010). The interval time from first surgical resection to diagnosis of GRC was longer in cases of previous peptic ulcer than in cases of previous gastric cancer (29.2±10.6 vs 12.7±12.9 years; P = 0.000). Tumors located in anastomotic sites were more common in Billroth II reconstruction than in Billroth I reconstruction (73.0% vs 28.6%; P = 0.001). Borrmann type IV cancers had a high incidence of larger tumor size, undifferentiated pathology and diffuse tumor in whole gastric remnant. The resection and radical resection rates of GRC were 68.2% (58/85) and 55.3% (47/85), respectively. The overall 1-, 3-, and 5-year survival rates of patients who underwent radical resection were 70.2%, 38.4% and 32.4%, respectively. Univariate analysis showed that the significant factors affecting survival included tumor location, differentiation, tumor diameter, anemia, serum carcino-embryonic antigen (CEA) level, depth of invasion, nodal metastasis, distant metastasis, TNM stage, curability, resection combined with organs, and Borrmann type (all P < 0.05); whereas differentiation, anemia, serum CEA level and distant metastasis were independent prognostic factors in multivariable analysis (all P < 0.05). Conclusion: The factors influencing the prognosis of GRC include differentiation, anemia, serum CEA level and distant metastasis. Regular follow-up is essential for monitoring the occurrence and evaluating the prognosis of GRC after gastrectomy, regardless of peptic ulcer or gastric cancer.