Upper GI
Andrew Hanna, MD
Resident
University of Pennsylvania
Philadelphia, Pennsylvania, United States
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Lymph node involvement is a powerful predictor of recurrence after gastrectomy for gastric adenocarcinoma. Clinicopathologic predictors of recurrence in patients with node-negative disease are less well established.
Methods:
Patients who underwent curative-intent resection for gastric adenocarcinoma between 2010 and 2020 at a single center were analyzed; patients that died within 30 days were excluded. Univariate and multivariate Cox regression analyses were used to determine factors associated with recurrence. The factors that were significant on multivariate analysis were subsequently used to generate a scoring system to predict recurrence. All statistical analyses were performed using R version 4.1.1.
Results:
Of 233 patients who met inclusion criteria, 114 (48.9%) had node-negative disease by pathologic staging, with an average of 28.3 lymph nodes analyzed per patient. Within the node-negative cohort, 37 (32.5%) received perioperative chemotherapy and 5 (4.4%) received radiotherapy. Fifteen (13.2%) node-negative patients recurred, with median recurrence free survival of 11.4 months and mean overall survival of 19.0 months. On univariate analysis, factors associated with recurrence were administration of neoadjuvant chemotherapy (p < 0.05), higher T-stage (p < 0.001), and presence of lymphovascular invasion (p=0.001). Multivariate Cox regression analysis demonstrated T-stage 2 or higher (hazard ratio [HR] = 6.06, 95% confidence interval [CI]: 1.6–22.9), grade 3 or 4 histology (HR=5.7, 95% CI: 1.5-16.9), and presence of lymphovascular invasion (HR=4.0, 95% CI: 1.3-12.4) to be associated with recurrence. A scoring system based on this multivariable model was predictive of recurrence (Figure 1, p < 0.001).
Conclusions:
In the absence of lymph node involvement, patients with higher T-stage, grade, or presence of lymphovascular invasion have significantly shorter time to recurrence, and may benefit from more aggressive or novel multimodality treatment approaches.