Risk Factors of the Recurrence after a Curative Resection of Gastric Carcinoma Invading the Muscularis Propria

ABSTRACT

PURPOSE: Advanced gastric cancer confined to the muscularis propria is considered to be an intermediate-stage carcinoma, between early and more advanced cancer from both the pathological and clinical viewpoints of the primary tumor stage. Although many prognostic factors for early gastric cancer and advanced gastric cancer have been identified, there are few reports concerning prognostic factors for gastric cancer invading the muscularis propria, and the characteristics of recurrence are not completley understood. METHODS: One hundred and fifty-six patients who had undergone curative resection for gastric cancer invading the muscularis propria from 1992 to 2000 were retrospectively reviewed. The risk factors that determined the recurrence were investigated by univariate and multivariate analysis. RESULTS: Disease recurred in 31 patient (19.9%) after a median interval of 17.2 months. Based on our univariate analysis, the recurrence was associated with lymph node metastasis, tumor size and histologic type. Multivariate analysis showed that independent risk factor for the recurrence was only lymph node metastasis. Recurrent disease patterns included hematogenous (38.7%), peritoneal (16.1%) and locoregional (25.8%). CONCLUSION: Lymph node metastasis is an important risk factor of the recurrence after curative resection for gastric cancer invading the muscularis propria. Patients with lymphatic metastasis, particularly with 4 or more nodal imvolvements, should undergo postoperative adjuvant therapy.