Early and late recurrence after gastrectomy for gastric carcinoma - Univariate and multivariate analyses

BACKGROUND. To the authors' knowledge, there are few studies regarding the predictors of early and late recurrence after gastrectomy for gastric carci noma, and it is unknown whether prognostic factors can be applied to the ti ming of recurrence. The current study analyzed patients who died of recurre nt gastric carcinoma and clarified histopathologic indicators associated wi th early and tate recurrence. METHODS. The study included 138 patients who died of recurrent gastric carc inoma after gastrectomy that was performed in the Department of Surgery I, Oita Medical University, between 1982-1995. Clinicopathologic findings were com pared between 104 patients who died within 2 years after gastrectomy ( early recurrence group) and 34 patients who died > 2 years after gastrectom y (late recurrence group). Multivariate analysis was performed to determine the independent factors correlated with the timing of recurrence. RESULTS. When compared with the late recurrence group, the early recurrence group was characterized by a tumor size greater than or equal to 5 cm (92% in the early recurrence group vs. 74% in the late recurrence group), posit ive lymphatic invasion (64% vs. 38%), extended lymph node metastasis (73% v s. 35%), Stage III or TV disease (87% vs. 62%), and limited lymph node diss ection (32% vs. 3%). The mean survival time was influenced by the lymphatic invasion (P < 0.01), vascular invasion (P < 0.05), level of lymph node met astasis (P < 0.01), stage of disease (P < 0.01), and extent of lymph node d issection (P < 0.01). On multivariate analysis, survival time was found to be associated independently with the stage of disease (Stage I, II vs. Stag e III, IV or the level of lymph node metastasis (N0, N1 vs. N2, N3). CONCLUSIONS, The stage of disease and level of lymph node metastasis were f ound to be the most significant factors independently associated with the s urvival time after gastrectomy for gastric carcinoma. Patients with more ad vanced stage of disease (Stage III, IV) or those with extended lymph node m etastasis (N2, N3) frequently died of recurrence within 2 years after gastr ectomy. (C) 2000 American Cancer Society.