title: Conventional clinical and pathological features fail to accurately predict recurrence in patients with gastric cancer staged N0.
abstract: BACKGROUND
  Despite the medical-surgical advances, even after R0 gastric resections, some patients without apparent metastatic disease develop cancer recurrence and eventually die.
  
  
  OBJECTIVE
  We aimed to define recurrence in patients with node-negative gastric adenocarcinoma and to determine whether any clinicopathological features are predictive for recurrence.
  
  
  METHODS
  This was a retrospective cohort study on patients with gastric adenocarcinoma, consecutively diagnosed at our institution, staged as N0M0 between January 2000 and December 2008.
  
  
  RESULTS
  We recruited 129 patients; 53% were men and 56% were older than 60 years. A total of 22% of the patients developed recurrence, with a mortality rate of 93%. Overall, 71% of the patients, N0, with recurrence presented lymphatic permeation. In univariate analysis, on comparing recurrent patients with those with no recurrence, age, size, T status, lymphatic, and venous permeation were factors that were associated significantly with recurrence, but in multivariate analysis, only age (odds ratio:19.5; 95% confidence interval: 2.3-168; P=0.008) and venous permeation (odds ratio: 6.34; 95% confidence interval: 1.8-22.8; P=0.005) were associated with recurrence. On the basis of only these two factors, the proportion of missed recurrent patients by age and venous permeation was 13 and 39%, respectively.
  
  
  CONCLUSIONS
  A total of 22% of patients, N0, developed recurrence of their disease. Age and venous permeation were independent risk factors for recurrence, but on the basis of these factors, up to 40% of patients may be missed for recurrence. New methods to predict recurrence are needed.
authors: aGeneral Surgery Department of Centro Hospitalar de Vila Nova de Gaia/Espinho bFaculty of Health Sciences of Universidade Fernando Pessoa, Vila Nova de Gaia cInstitute of Biomedical Sciences Abel Salazar, Universidade do Porto dCIDES/CINTESIS, Department of Portuguese Oncology Institute of Porto, Oporto Faculty of Medicine and Gastroenterology eGastroenterology Department of Portuguese Oncology Institute of Porto, Porto, Portugal.
authors: Amelia
authors: A
authors: Tavares
authors: Fernando
authors: F
authors: Viveiros
authors: Jorge
authors: J
authors: Maciel
authors: Mário
authors: M
authors: Dinis-Ribeiro
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D016019:Survival Analysis