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Venous Invasion Is a Risk Factor for Recurrence of pT1 Gastric Cancer with Lymph Node Metastasis

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Postoperative adjuvant therapy for early gastric cancer (EGC) has not been widely studied, and there are differing indications for postoperative adjuvant therapy between Western and Asian countries. Japanese gastric cancer treatment guidelines do not recommend adjuvant chemotherapy for EGC, but it is unclear whether surgery alone is the most appropriate treatment.

Methods

This is a single-center retrospective study of 1001 consecutive patients who underwent radical gastrectomy for pT1 gastric cancer between 1999 and 2013 at the Wakayama Medical University Hospital.

Results

Recurrence was observed in 12 patients, nine of whom as the result of hematogenous metastasis. In all patients with pT1 gastric cancer (n = 1001), lymph node metastasis was identified as an independent predictive factor for recurrence (hazard ratio [HR] = 10.910, P = 0.002). In patients with pT1N + gastric cancer, however, the 5-year disease-specific survival (DSS) rate was still high, 90.8%. In patients with pT1N + gastric cancer (n = 97), the presence of venous invasion (pT1N + v +) was identified by univariate and multivariate analyses as an independent risk factor for recurrence (HR = 4.791, P = 0.032). In patients with venous invasion, the 5-year DSS rate was significantly lower than that in those without venous invasion (79.3% vs. 95.2%, P = 0.018).

Conclusions

Long-term prognosis of patients with EGC with lymph node metastasis is good, but venous invasion is associated with a higher risk of recurrence. Selective application of postoperative adjuvant chemotherapy for pT1N + v + gastric cancer may efficiently improve prognosis among patients with EGC.

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Acknowledgements

We acknowledge proofreading and editing by Benjamin Phillis at the Clinical Study Support Center, Wakayama Medical University.

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Authors and Affiliations

  1. Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, 641-8510, Japan

    Akihiro Takeuchi, Toshiyasu Ojima, Masahiro Katsuda, Keiji Hayata, Taro Goda, Junya Kitadani, Shinta Tominaga, Naoki Fukuda, Tomoki Nakai & Hiroki Yamaue

Authors
  1. Akihiro Takeuchi
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  2. Toshiyasu Ojima
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  3. Masahiro Katsuda
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  4. Keiji Hayata
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  5. Taro Goda
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  6. Junya Kitadani
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  7. Shinta Tominaga
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  8. Naoki Fukuda
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  9. Tomoki Nakai
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  10. Hiroki Yamaue
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Contributions

AT designed the study and wrote the initial draft of the manuscript. AT and TO contributed to data interpretation and critical revision of the manuscript. All the other authors (MK, KH, TG, JK, ST, NF, TN, and HY) contributed to data collection and interpretation and critical review of the manuscript. All authors have read and approved the final version of the manuscript and have agreed to be accountable for all aspects of the study, ensuring that any queries related to the accuracy or integrity of any part of the work are answerable.

Corresponding author

Correspondence to Toshiyasu Ojima.

Ethics declarations

Ethics Approval and Consent to Participate

This study was approved by the Wakayama Medical University Institutional Review Board. All procedures were undertaken in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent to be included in the study, or the equivalent, was obtained from all patients.

Conflict of Interest

The authors declare no competing interests.

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Takeuchi, A., Ojima, T., Katsuda, M. et al. Venous Invasion Is a Risk Factor for Recurrence of pT1 Gastric Cancer with Lymph Node Metastasis. J Gastrointest Surg 26, 757–763 (2022). https://doi.org/10.1007/s11605-021-05238-0

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  • DOI: https://doi.org/10.1007/s11605-021-05238-0

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