title: Factors Associated With Recurrence and Survival in Lymph Node-negative Gastric Adenocarcinoma: A 7-Institution Study of the US Gastric Cancer Collaborative.
abstract: OBJECTIVE
  To determine pathologic features associated with recurrence and survival in patients with lymph node-negative gastric adenocarcinoma.
  
  
  METHODS
  Multi-institutional retrospective analysis.
  
  
  BACKGROUND
  Lymph node status is among the most important predictors of recurrence after gastrectomy for gastric adenocarcinoma. Pathologic features predictive of recurrence in patients with node-negative disease are less well established.
  
  
  METHODS
  Patients who underwent curative resection for gastric adenocarcinoma between 2000 and 2012 from 7 institutions of the US Gastric Cancer Collaborative were analyzed, excluding 30-day mortalities and stage IV disease. Competing risks regression and multivariate Cox regression were used to determine pathologic features associated with time to recurrence and overall survival. Differences in cumulative incidence of recurrence were assessed using the Gray method (for univariate nonparametric analyses) and the Fine and Gray method (for multivariate analyses) and shown as subhazard ratios (SHRs) and adjusted subhazard ratios (aSHRs), respectively.
  
  
  RESULTS
  Of 805 patients who met inclusion criteria, 317 (39%) had node-negative disease, of which 54 (17%) recurred. By 2 and 5 years, 66% and 88% of patients, respectively, experienced recurrence. On multivariate competing risks regression, only T-stage 3 or higher was associated with shorter time to recurrence [aSHR = 2.7; 95% confidence interval (CI), 1.5-5.2]. Multivariate Cox regression showed T-stage 3 or higher [hazard ratio (HR) = 1.8; 95% CI, 1.2-2.8], lymphovascular invasion (HR = 2.2; 95% CI, 1.4-3.4), and signet ring histology (HR = 2.1; 95% CI, 1.2-3.6) to be associated with decreased overall survival.
  
  
  CONCLUSIONS
  Despite absence of lymph node involvement, patients with T-stage 3 or higher have a significantly shorter time to recurrence. These patients may benefit from more aggressive adjuvant therapy and postoperative surveillance regimens.
authors.affiliation: *Department of Surgery, Barnes Jewish Hospital and The Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO †Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA ‡Department of Surgery, Stanford University Medical Center, Stanford, CA §Department of Surgery, Wake Forest University, Winston-Salem, NC ¶Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI ||Department of Surgery, The Ohio State University Comprehensive Cancer Center, Columbus, OH **Division of Surgical Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Linda X
authors.initials: LX
authors.lastname: Jin
authors.forename: Lindsey E
authors.initials: LE
authors.lastname: Moses
authors.forename: M Hart
authors.initials: MH
authors.lastname: Squires
authors.forename: George A
authors.initials: GA
authors.lastname: Poultsides
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Votanopoulos
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Weber
authors.forename: Mark
authors.initials: M
authors.lastname: Bloomston
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
authors.forename: William G
authors.initials: WG
authors.lastname: Hawkins
authors.forename: David C
authors.initials: DC
authors.lastname: Linehan
authors.forename: Steven M
authors.initials: SM
authors.lastname: Strasberg
authors.forename: Carl
authors.initials: C
authors.lastname: Schmidt
authors.forename: David J
authors.initials: DJ
authors.lastname: Worhunsky
authors.forename: Alexandra W
authors.initials: AW
authors.lastname: Acher
authors.forename: Kenneth
authors.initials: K
authors.lastname: Cardona
authors.forename: Clifford S
authors.initials: CS
authors.lastname: Cho
authors.forename: David A
authors.initials: DA
authors.lastname: Kooby
authors.forename: Edward
authors.initials: E
authors.lastname: Levine
authors.forename: Emily R
authors.initials: ER
authors.lastname: Winslow
authors.forename: Neil D
authors.initials: ND
authors.lastname: Saunders
authors.forename: Gaya
authors.initials: G
authors.lastname: Spolverato
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Fields
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States