Tumor Biology

, Volume 36, Issue 8, pp 6191–6199 | Cite as

Prognostic significance of the recurrence pattern and risk factors for recurrence in patients with proximal gastric cancer who underwent curative gastrectomy

  • Ahmet Bilici
  • Fatih Selcukbiricik
Research Article


Proximal gastric cancer has a high propensity of early recurrence after curative resection due to high incidence of lymph node involvement. In the present study, we aimed to investigate the pattern and time of recurrence and to evaluate the risk factors for recurrence of patients with proximal gastric cancer. Between 2005 and 2013, 99 patients with recurrent proximal gastric cancer who underwent radical gastrectomy were retrospectively analyzed. The prognostic significance of the pattern and the time of recurrence and the relationship between the pattern of recurrence and the other clinicopathological factors were evaluated. The median time to recurrence was 24 months; 45.5 % of patients relapsed within 2 years. Forty-three (43.4 %) patients indicated hematogenous recurrence and 41 (41.4 %) patients revealed peritoneal recurrence with the most predominant patterns. The median progression-free survival (PFS) time for patients with locoregional recurrence was significantly better than that of patients with peritoneal recurrences, hematogenous recurrences, and distant lymph nodes (32.2 vs. 18.9 vs. 18.2 vs. 9.7 months, p = 0.005, respectively). Moreover, the median overall survival (OS) interval for patients with distant lymph nodes recurrence was significantly worse than that of patients with locoregional, peritoneal, and hematogenous recurrences (13.5 vs. 48.5 vs. 31.4 vs. 29.9 months, p = 0.006, respectively). The presence of lymph node metastasis (p = 0.004) and surgery type (p = 0.04) for PFS and the time of recurrence (p = 0.033), lymph node metastasis (p = 0.03), and surgery type (p = 0.04) for OS were found to be independent prognostic factors by multivariate analysis. Logistic regression analysis indicated that the presence of lymph node metastasis and surgery type were independent risk factors for predicting the occurrence of early recurrence (p = 0.001, OR 0.48 and p = 0.028, OR 0.41, respectively). The median OS time of early recurrence patients was significantly shorter than that of patients with late recurrence (16.6 vs. 55.2 months, p < 0.001). Furthermore, proximal gastrectomy, poorly differentiated histology, advanced pT stage, and lymph node metastasis were significantly associated with early recurrence. Our results showed that lymph node metastasis and surgery type were independent risk factors for prediction of early recurrence in proximal gastric cancer. Thus, total gastrectomy with regional lymph node dissection may be a suitable treatment option for proximal gastric cancer patients with tumors that have high risk features for recurrence.


Proximal gastric cancer Recurrence pattern Prognosis Survival 


Conflict of interest



  1. 1.
    Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013;63:11–30.CrossRefPubMedGoogle Scholar
  2. 2.
    Crew KD, Neugut AI. Epidemiology of gastric cancer. World J Gastroenterol. 2006;12:354–62.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Whiting J, Sano T, Saka M, Fukagawa T, Katai H, Sasako M. Follow-up of gastric cancer: a review. Gastric Cancer. 2006;9:74–81.CrossRefPubMedGoogle Scholar
  4. 4.
    Yoo CH, Noh SH, Shin DW, Choi SH, Min JS. Recurrence following curative resection for gastric carcinoma. Br J Surg. 2000;87:236–42.CrossRefPubMedGoogle Scholar
  5. 5.
    Huang KH, Chen JH, Wu CW, Lo SS, Hsieh MC, Li AF, et al. Factors affecting recurrence in node-negative advanced gastric cancer. J Gastroenterol Hepatol. 2009;24:1522–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Marrelli D, Roviello F, de Manzoni G, Morgagni P, Di Leo A, Saragoni L, et al. Different patterns of recurrence in gastric cancer depending on Lauren’s histological type: longitudinal study. World J Surg. 2002;26:1160–5.CrossRefPubMedGoogle Scholar
  7. 7.
    Böhner H, Zimmer T, Hopfenmüller W, Berger G, Buhr HJ. Detection and prognosis of recurrent gastric cancer—is routine follow-up after gastrectomy worthwhile? Hepatogastroenterology. 2000;47:1489–94.PubMedGoogle Scholar
  8. 8.
    Kodera Y, Ito S, Yamamura Y, Mochizuki Y, Fujiwara M, Hibi K, et al. Follow-up surveillance for recurrence after curative gastric cancer surgery lacks survival benefit. Ann Surg Oncol. 2003;10:898–902.CrossRefPubMedGoogle Scholar
  9. 9.
    Lai JF, Kim S, Kim K, Li C, Oh SJ, Hyung WJ, et al. Prediction of recurrence of early gastric cancer after curative resection. Ann Surg Oncol. 2009;16:1896–902.CrossRefPubMedGoogle Scholar
  10. 10.
    Shiraishi N, Inomata M, Osawa N, Yasuda K, Adachi Y, Kitano S. Early and late recurrence after gastrectomy for gastric carcinoma. Univariate and multivariate analyses. Cancer. 2000;89:255–61.CrossRefPubMedGoogle Scholar
  11. 11.
    Yokota T, Saito T, Teshima S, Yamada Y, Iwamoto K, Takahashi M, et al. Early and late recurrences after gastrectomy for gastric cancer: a multiple logistic regression analysis. Ups J Med Sci. 2002;107:17–22.CrossRefPubMedGoogle Scholar
  12. 12.
    Schwarz RE, Zagala-Nevarez K. Recurrence patterns after radical gastrectomy for gastric cancer: prognostic factors and implications for postoperative adjuvant therapy. Ann Surg Oncol. 2002;9(4):394–400.CrossRefPubMedGoogle Scholar
  13. 13.
    Yang L. Incidence and mortality of gastric cancer in China. World J Gastroenterol. 2006;12:17–20.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Kubo A, Corley DA. Marked regional variation in adenocarcinomas of the esophagus and the gastric cardia in the United States. Cancer. 2002;95:2096–102.CrossRefPubMedGoogle Scholar
  15. 15.
    Corley DA, Buffler PA. Oesophageal and gastric cardia adenocarcinomas: analysis of regional variation using the Cancer Incidence in Five Continents database. Int J Epidemiol. 2001;30:1415–25.CrossRefPubMedGoogle Scholar
  16. 16.
    Ishikawa S, Shimada S, Miyanari N, Hirota M, Takamori H, Baba H. Pattern of lymph node involvement in proximal gastric cancer. World J Surg. 2009;33:1687–92.CrossRefPubMedGoogle Scholar
  17. 17.
    Li F, Zhang R, Liang H, Liu H, Quan J. The pattern and risk factors of recurrence of proximal gastric cancer after curative resection. J Surg Oncol. 2013;107:130–5.CrossRefPubMedGoogle Scholar
  18. 18.
    AJCC (American Joint Committee on Cancer) Cancer Staging Manual, 7th ed, Edge, SB, Byrd, DR, Compton, CC, et al (Eds), Springer, New York 2010. p. 117.Google Scholar
  19. 19.
    Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma. 2nd English ed. Gastric Cancer 1998; 1: 10-24.Google Scholar
  20. 20.
    Harrison LE, Karpeh MS, Brennan MF. Proximal gastric cancers resected via a transabdominal-only approach. Results and comparisons to distal adenocarcinoma of the stomach. Ann Surg. 1997;225:678–83.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Saito H, Fukumoto Y, Osaki T, Fukuda K, Tatebe S, Tsujitani S, et al. Distinct recurrence pattern and outcome of adenocarcinoma of the gastric cardia in comparison with carcinoma of other regions of the stomach. World J Surg. 2006;30:1864–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Gulmann C, Hegarty H, Grace A, Leader M, Patchett S, Kay E. Differences in proximal (cardia) versus distal (antral) gastric carcinogenesis via the retinoblastoma pathway. World J Gastroenterol. 2004;10:17–21.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Kim JH, Park SS, Kim J, Boo YJ, Kim SJ, Mok YJ, et al. Surgical outcomes for gastric cancer in the upper third of the stomach. World J Surg. 2006;30:1870–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Kunisaki C, Shimada H, Nomura M, Matsuda G, Otsuka Y, Ono H, et al. Surgical outcome in patients with gastric adenocarcinoma in the upper third of the stomach. Surgery. 2005;137:165–71.CrossRefPubMedGoogle Scholar
  25. 25.
    Zhang XF, Huang CM, Lu HS, Wu XY, Wang C, Guang GX, et al. Surgical treatment and prognosis of gastric cancer in 2,613 patients. World J Gastroenterol. 2004;10:3405–8.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© International Society of Oncology and BioMarkers (ISOBM) 2015

Authors and Affiliations

  1. 1.Department of Medical Oncology, Medical FacultyIstanbul Medipol UniversityIstanbulTurkey
  2. 2.Department of Medical OncologySisli Etfal Education and Research HospitalIstanbulTurkey
  3. 3.BagcilarTurkey

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