Clinicopathological Characteristics of Recurred Gastric Cancer Patients after Curative Surgery

ABSTRACT

PURPOSE: More than half of the gastric cancer patients are diagnosed at an advanced stage, and many of them recur in spite of curative surgery. Because of that fact, analysis of the characteristics of recurrence and development of a more effective treatment are urgent problems. METHODS: One hundred gastric cancer patients who recurred after curative surgery were enrolled for this study, and 518 patients living without recurrence were used as a control group. Various clinicopathological factors were compared between the recurred and the non-recurred groups. RESULTS: Among the 100 recurred patients, peritoneal seeding (P/S) was found in 46 patients, hematogenous spread (H-S) in 20 patients, loco-regional recurrence (LR-R) in 15 patients mixed type in 19 patients. Depth of invasion, lymph node metastasis, incidence of total gastrectomy, preoperative CA19-9 level, lymphatic and venous invasion, and tumor size were significantly different between the recurred and the non-recurred groups. In cases with P/S and H-R, undifferentiated tumors were more frequent than differentiated tumors to the contrary differentiated tumors were more common in LR-R. More than 80% of the recurrences were emerged within 2 years after surgery. At the time of recurrence, the serum levels of CEA and CA 19-9 were positive of 45% and 45% of the patients respectively. In P/S, patients with operative treatment survived longer than patients receiving other kinds of treatment (p=0.019), and chemotherapy effectively lengthened the survival in mixed type recurrence (p=0.018). CONCLUSION: The two years following surgery was the most important period for recurrence, and lymphatic invasion was related to such early recurrence with a statistical significance. Measurement of the serum levels of tumor markers was useful for the detection of recurrence. Operative treatment or chemotherapy was effective for lengthening the period of survival after recurrence in some types of recurrence.