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The association of the lymph node ratio and serum carbohydrate antigen 19-9 with early recurrence after curative gastrectomy for gastric cancer

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Abstract

Purpose

This study investigated the predictors associated with early recurrence (i.e. within 12 months) after curative gastrectomy for gastric cancer (GC).

Methods

We evaluated the clinicopathological factors in 429 patients who underwent curative gastrectomy for GC without preoperative chemotherapy and analyzed these factors’ associations with early recurrence.

Results

Of 429 patients, 57 experienced recurrences, which were associated with gender, diameter, depth of invasion, lymph node (LN) metastasis, the LN ratio (LNr; LNs with metastasis/dissected LNs), lymphatic invasion, vascular invasion, carbohydrate antigen 19-9 (CA19-9) levels, C-reactive protein levels and the neutrophil/lymphocyte ratio. Twenty-one patients (36.8%) recurred within 12 months. Early recurrence was associated with a high LNr (P = 0.0020) and high CA19-9 levels (P = 0.0415). The other factors were not significantly associated with early recurrence. The 12-month recurrence rate was 33.9% in patients with a high LNr and 1.9% in those with a low LNr and 20.3% in patients with high CA19-9 levels and 3.5% in those with low CA19-9 levels. The 12-month recurrence rate was 62.5% in patients with a high LNr and high CA19-9 levels, 18.4% in those with a high LNr or high-CA19-9 levels, and 1.4% in those with a low LNr and low CA19-9 levels.

Conclusion

LNr ≥ 0.15 and CA19-9 ≥ 37 U/ml were effective surrogate markers for predicting early recurrence.

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Abbreviations

CA19-9:

Carbohydrate antigen 19-9

CEA:

Carcinoembryonic antigen

CI:

Confidence interval

CRP:

C-reactive protein

CT:

Computed tomography

GC:

Gastric cancer

HR:

Hazard ratio

LN:

Lymph node

LNr:

Lymph node ratio

NLR:

Neutrophil/lymphocyte ratio

ROC:

Receiver operating characteristic

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan

    Hiroshi Sawayama, Masaaki Iwatsuki, Daisuke Kuroda, Tasuku Toihata, Tomoyuki Uchihara, Yuki Koga, Taisuke Yagi, Yuki Kiyozumi, Tsugio Eto, Yukiharu Hiyoshi, Takatsugu Ishimoto, Yoshifumi Baba, Yuji Miyamoto, Naoya Yoshida & Hideo Baba

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  1. Hiroshi Sawayama
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  2. Masaaki Iwatsuki
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Corresponding author

Correspondence to Hideo Baba.

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Conflict of interest

The authors have no conflicts of interest directly relevant to the content of this article.

Ethical standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the 1964 Declaration of Helsinki and later versions. Informed consent was obtained from all patients for inclusion in the study.

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Sawayama, H., Iwatsuki, M., Kuroda, D. et al. The association of the lymph node ratio and serum carbohydrate antigen 19-9 with early recurrence after curative gastrectomy for gastric cancer. Surg Today 48, 994–1003 (2018). https://doi.org/10.1007/s00595-018-1684-1

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  • DOI: https://doi.org/10.1007/s00595-018-1684-1

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