Patterns of recurrence after curative D2 resection for gastric cancer: Implications for postoperative radiotherapy
Abstract Background High‐quality randomized controlled trials have demonstrated the benefit of radiotherapy (RT) in patients with radical resected gastric cancer (GC), however, utilization rates of postoperative RT remain remarkably low. Patterns, incidences, and time of recurrence provide biologica...
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Wiley
2020-07-01
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| Series: | Cancer Medicine |
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| Online Access: | https://doi.org/10.1002/cam4.3085 |
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| author | Jing Xu Li Shen Yongjie Shui Wei Yu Qingqu Guo Risheng Yu Yulian Wu Qichun Wei |
| author_facet | Jing Xu Li Shen Yongjie Shui Wei Yu Qingqu Guo Risheng Yu Yulian Wu Qichun Wei |
| author_sort | Jing Xu |
| collection | DOAJ |
| description | Abstract Background High‐quality randomized controlled trials have demonstrated the benefit of radiotherapy (RT) in patients with radical resected gastric cancer (GC), however, utilization rates of postoperative RT remain remarkably low. Patterns, incidences, and time of recurrence provide biological bases for clinical monitoring of GC patients and guiding potential complementary therapies. Thus, the aim of this study is to understand the location of locoregional recurrence which may allow individualized RT strategies and minimize radiation‐related toxic effects. Methods A relatively large sample of GC patients in a single institution who had undergone curative D2 resection was retrospectively reviewed and the relevant recurrence patterns were illustrated. Independent recurrence‐related risk factors were analyzed by logistic regression analysis. New logistic regression models were further developed to predict the probability of recurrence. Results Overall, among 776 GC patients who had continuous and complete follow‐up data, 300 cases relapsed after curative resection. Lymphovascular invasion, lymph node metastases, and tumor stage were indicators for early recurrence. Peritoneal, regional, local, and distant recurrence initially occurred in 51 (6.6%), 151 (19.4%), 56 (7.2%), and 164 (21.1%) patients, respectively. Among patients with regional recurrence, the most common sites were lymph node stations 16a2, 8, 12, 16b1, and 9. Remnant stomach recurrence was not so prominent that it seemed reasonable to be excluded from an irradiation field for patients with negative surgical/pathologic margins. Conclusions For GC patients who underwent radical D2 resection, distant and regional recurrences were still common. Besides, optimizing regional control of lymph nodes outside the D2 dissected area was crucial for rational design of the RT field. Furthermore, the new logistic regression models might act as useful tools to evaluate recurrence risk and determine which patients should receive postoperative chemoradiotherapy. |
| format | Article |
| id | doaj-art-6c69f33eb9c84937b84c40468ede03a6 |
| institution | DOAJ |
| issn | 2045-7634 |
| language | English |
| publishDate | 2020-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj-art-6c69f33eb9c84937b84c40468ede03a62025-08-20T02:40:13ZengWileyCancer Medicine2045-76342020-07-019134724473510.1002/cam4.3085Patterns of recurrence after curative D2 resection for gastric cancer: Implications for postoperative radiotherapyJing Xu0Li Shen1Yongjie Shui2Wei Yu3Qingqu Guo4Risheng Yu5Yulian Wu6Qichun Wei7Department of Radiation Oncology the Second Affiliated Hospital and Cancer Institute (National Ministry of Education Key Laboratory of Cancer Prevention and Intervention) Zhejiang University School of Medicine Hangzhou P.R. ChinaDepartment of Radiation Oncology the Second Affiliated Hospital and Cancer Institute (National Ministry of Education Key Laboratory of Cancer Prevention and Intervention) Zhejiang University School of Medicine Hangzhou P.R. ChinaDepartment of Radiation Oncology the Second Affiliated Hospital and Cancer Institute (National Ministry of Education Key Laboratory of Cancer Prevention and Intervention) Zhejiang University School of Medicine Hangzhou P.R. ChinaDepartment of Radiation Oncology the Second Affiliated Hospital and Cancer Institute (National Ministry of Education Key Laboratory of Cancer Prevention and Intervention) Zhejiang University School of Medicine Hangzhou P.R. ChinaDepartment of Surgery the Second Affiliated HospitalZhejiang University School of Medicine Hangzhou P.R. ChinaDepartment of Radiology the Second Affiliated HospitalZhejiang University School of Medicine Hangzhou P.R. ChinaDepartment of Surgery the Second Affiliated HospitalZhejiang University School of Medicine Hangzhou P.R. ChinaDepartment of Radiation Oncology the Second Affiliated Hospital and Cancer Institute (National Ministry of Education Key Laboratory of Cancer Prevention and Intervention) Zhejiang University School of Medicine Hangzhou P.R. ChinaAbstract Background High‐quality randomized controlled trials have demonstrated the benefit of radiotherapy (RT) in patients with radical resected gastric cancer (GC), however, utilization rates of postoperative RT remain remarkably low. Patterns, incidences, and time of recurrence provide biological bases for clinical monitoring of GC patients and guiding potential complementary therapies. Thus, the aim of this study is to understand the location of locoregional recurrence which may allow individualized RT strategies and minimize radiation‐related toxic effects. Methods A relatively large sample of GC patients in a single institution who had undergone curative D2 resection was retrospectively reviewed and the relevant recurrence patterns were illustrated. Independent recurrence‐related risk factors were analyzed by logistic regression analysis. New logistic regression models were further developed to predict the probability of recurrence. Results Overall, among 776 GC patients who had continuous and complete follow‐up data, 300 cases relapsed after curative resection. Lymphovascular invasion, lymph node metastases, and tumor stage were indicators for early recurrence. Peritoneal, regional, local, and distant recurrence initially occurred in 51 (6.6%), 151 (19.4%), 56 (7.2%), and 164 (21.1%) patients, respectively. Among patients with regional recurrence, the most common sites were lymph node stations 16a2, 8, 12, 16b1, and 9. Remnant stomach recurrence was not so prominent that it seemed reasonable to be excluded from an irradiation field for patients with negative surgical/pathologic margins. Conclusions For GC patients who underwent radical D2 resection, distant and regional recurrences were still common. Besides, optimizing regional control of lymph nodes outside the D2 dissected area was crucial for rational design of the RT field. Furthermore, the new logistic regression models might act as useful tools to evaluate recurrence risk and determine which patients should receive postoperative chemoradiotherapy.https://doi.org/10.1002/cam4.3085gastric cancerradical surgeryradiotherapyrecurrence patterns |
| spellingShingle | Jing Xu Li Shen Yongjie Shui Wei Yu Qingqu Guo Risheng Yu Yulian Wu Qichun Wei Patterns of recurrence after curative D2 resection for gastric cancer: Implications for postoperative radiotherapy Cancer Medicine gastric cancer radical surgery radiotherapy recurrence patterns |
| title | Patterns of recurrence after curative D2 resection for gastric cancer: Implications for postoperative radiotherapy |
| title_full | Patterns of recurrence after curative D2 resection for gastric cancer: Implications for postoperative radiotherapy |
| title_fullStr | Patterns of recurrence after curative D2 resection for gastric cancer: Implications for postoperative radiotherapy |
| title_full_unstemmed | Patterns of recurrence after curative D2 resection for gastric cancer: Implications for postoperative radiotherapy |
| title_short | Patterns of recurrence after curative D2 resection for gastric cancer: Implications for postoperative radiotherapy |
| title_sort | patterns of recurrence after curative d2 resection for gastric cancer implications for postoperative radiotherapy |
| topic | gastric cancer radical surgery radiotherapy recurrence patterns |
| url | https://doi.org/10.1002/cam4.3085 |
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