title: Factors associated with early recurrence after curative surgery for gastric cancer.
abstract: OBJECTIVE
  To characterize patterns of gastric cancer recurrence and patient survival and to identify predictors of early recurrence after surgery.
  
  
  METHODS
  Clinicopathological data for 417 consecutive patients who underwent curative resection for gastric cancer were retrospectively analyzed. Tumor and node status was reclassified according to the 7(th) edition of the American Joint Committee on Cancer tumor-node-metastasis classification for carcinoma of the stomach. Survival data came from both the patients' follow-up records and telephone follow-ups. Recurrent gastric cancer was diagnosed based on clinical imaging, gastroscopy with biopsy, and/or cytological examination of ascites, or intraoperative findings in patients who underwent reoperation. Predictors of early recurrence were compared in patients with pT1 and pT2-4a stage tumors. Pearson's χ (2) test and Fisher's exact test were used to compare differences between categorical variables. Survival curves were constructed using the Kaplan-Meier method and compared via the log-rank test. Variables identified as potentially important for early recurrence using univariate analysis were determined by multivariate logistic regression analysis.
  
  
  RESULTS
  Of 417 gastric cancer patients, 80 (19.2%) were diagnosed with early gastric cancer and the remaining 337 (80.8%) were diagnosed with locally advanced gastric cancer. After a median follow-up period of 56 mo, 194 patients (46.5%) experienced recurrence. The mean time from curative surgery to recurrence in these 194 patients was 24 ± 18 mo (range, 1-84 mo). Additionally, of these 194 patients, 129 (66.5%) experienced recurrence within 2 years after surgery. There was no significant difference in recurrence patterns between early and late recurrence (P < 0.05 each). For pT1 stage gastric cancer, tumor size (P = 0.011) and pN stage (P = 0.048) were associated with early recurrence of gastric tumors. Patient age, pT stage, pN stage, Lauren histotype, lymphovascular invasion, intraoperative chemotherapy, and postoperative chemotherapy were independent predictors of early recurrence in patients with pT2-4a stage gastric cancer (P < 0.05 each).
  
  
  CONCLUSIONS
  Age, pT stage, pN stage, Lauren histotype, lymphovascular invasion, intraoperative chemotherapy, and postoperative chemotherapy are independent factors influencing early recurrence of pT2-4a stage gastric cancer.
authors.affiliation: Wei-Ming Kang, Jian-Chun Yu, Zhi-Qiang Ma, Zhi-Tian Li, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Kang
authors.affiliation: Wei-Ming Kang, Jian-Chun Yu, Zhi-Qiang Ma, Zhi-Tian Li, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
authors.forename: Qing-Bin
authors.initials: QB
authors.lastname: Meng
authors.affiliation: Wei-Ming Kang, Jian-Chun Yu, Zhi-Qiang Ma, Zhi-Tian Li, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
authors.forename: Jian-Chun
authors.initials: JC
authors.lastname: Yu
authors.affiliation: Wei-Ming Kang, Jian-Chun Yu, Zhi-Qiang Ma, Zhi-Tian Li, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
authors.forename: Zhi-Qiang
authors.initials: ZQ
authors.lastname: Ma
authors.affiliation: Wei-Ming Kang, Jian-Chun Yu, Zhi-Qiang Ma, Zhi-Tian Li, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
authors.forename: Zhi-Tian
authors.initials: ZT
authors.lastname: Li
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D000367:Age Factors; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Chemotherapy; D2 lymphadenectomy; Gastrectomy; Recurrence; Stomach neoplasms