679P - Identification of risk factors of relapse after curative surgical resection in stage I gastric cancer

Date 30 September 2012
Event ESMO Congress 2012
Session Poster presentation II
Topics Gastric Cancer
Surgery and/or Radiotherapy of Cancer
Presenter Ji Hyun Park
Authors J.H. Park1, M.H. Ryu2, H.J. Kim3, B. Ryoo2, I. Park4, Y.S. Park5, S.T. Oh6, J.H. Yook6, B.S. Kim6, Y. Kang7
  • 1Internal Medicine, Oncology, Asan medical center, 138-736 - Seoul/KR
  • 2Division Of Oncology, Dept Of Internal Medicine, Asan Medical Center, KR-138-736 - Seoul/KR
  • 3Clinical Epidemiology And Biostatistics, Asan Medical Center, Seoul/KR
  • 4Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul/KR
  • 5Department Of Pathology, Asan Medical Center, 138-736 - Seoul/KR
  • 6Department Of Surgery, Asan Medical Center, 138-736 - Seoul/KR
  • 7Dept. Of Oncology, Asan Medical Center, KR-138-736 - Seoul/KR

Abstract

Background

The therapeutic benefit of adjuvant chemotherapy is well established in stage (by AJCC 6th edition) II or III gastric cancer (GC). However, it has not been proven in stage I GC. The aim of this study was to identify risk factors of relapse in stage I GC, and to find out patients at high risk of relapse.

Methods

We retrospectively reviewed the medical records of 2783 patients with pathologically confirmed stage I GC who underwent curative surgical resection alone in Asan Medical Center between 2003 and 2007. Clinicopathologic parameters of exploration included: age, sex, histologic differentiation, WHO classification, Lauren classification, size, location, multiplicity, stage, lymphovascular or perineural invasion, preoperative serum levels of tumor markers (CEA, CA 19-9, CA 72-4), and type of surgery. Then, we performed univariate and multivariate analysis to correlate each parameter with relapse-free survival (RFS) and overall survival (OS).

Results

With a median follow-up of 54 months (range, 0-60), 213 (7.7 %) patients experienced recurrence or death, and 5-year RFS and OS was 90% and 94%, respectively. In univariate analysis, RFS was significantly related with age, sex, differentiation, WHO and Lauren classification, size, stage, lymphovascular invasion, perineural invasion, and serum levels of CEA and CA 19-9. The multiplicity of tumor instead of size was significantly related with OS. In multivariate analysis, 6 factors (age over 65 years, male, stage Ib, lymphovascular invasion, perineural invasion, and elevated level of CEA) remained independent poor prognostic factors for RFS (p <0.05). Four factors except the presence of lymphovascular or perineural invasion were also significantly related with inferior OS (p <0.05). Patients with more than two out of 6 poor risk factors had 79% of 5-year RFS, whereas patients with less risk factors had 97% of 5-year RFS (p <0.001).

Conclusion

In this study cohort, we identified 6 independent risk factors for relapse and death. The patients with more than two risk factors are expected to have significant risk of recurrence or death after curative resection, and should be considered as the future candidates of adjuvant treatment.

Disclosure

All authors have declared no conflicts of interest.