Recurrence in early gastric cancer--presence of micrometastasis in lymph node of node negative early gastric cancer patient with recurrence.
OBJECTIVE
There are cases of recurrence even after curative resection in early gastric cancer.


METHODS
Seven hundred and sixty-five patients with early gastric cancer who underwent curative gastrectomy were analyzed to identify the prognostic factor. Micrometastases within lymph nodes were determined by immunohistochemistry using anti-cytokeratin antibody in node-negative early gastric cancer patients with recurrence.


RESULTS
The recurrence was observed in 17 patients. Hematogenous recurrence was observed most frequently (47.1%), followed by peritoneal recurrence (23.5%). Of 17 patients with recurrence, 6 (35.3%) patients died more than 5 years after operation. The prognosis was poorer when the patients were older, and the depth of invasion was greater, lymph node metastasis, lymphatic involvement, and vascular involvement were present, and lymph node dissection was limited. The independent prognostic factors were lymph node metastasis, lymph node dissection, and age by multivariate analysis using Cox proportional hazards. Micrometastases within lymph nodes were confirmed in 3 of 6 node-negative patients with recurrence.


CONCLUSIONS
When patients have lymph node metastases or are older, close and long-term follow-up and careful planning of postoperative adjuvant therapy might be necessary to avoid recurrence. The detection of micrometastases by anti-cytokeratin antibody might be useful for predicting the possibility of recurrence in early gastric cancer.
Saito
Hiroaki
H
Department of Surgery, Division of Surgical Oncology, Tottori University School of Medicine, Yonago, Japan. sai10@grape.med.tottori-u.ac.jp
Osaki
Tomohiro
T
Murakami
Daiki
D
Sakamoto
Teruhisa
T
Kanaji
Shingo
S
Ohro
Shotaro
S
Tatebe
Shigeru
S
Tsujitani
Shunichi
S
Ikeguchi
Masahide
M
D000230:Adenocarcinoma / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D007124:Immunoenzyme Techniques; D007633:Keratins / Q000032:analysis; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009360:Neoplastic Cells, Circulating; D010534:Peritoneal Neoplasms / Q000473:pathology / Q000556:secondary; D011379:Prognosis; D016016:Proportional Hazards Models; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery
D007633:Keratins