title: Recursive partition analysis of peritoneal and systemic recurrence in patients with gastric cancer who underwent D2 gastrectomy: Implications for neoadjuvant therapy consideration.
abstract: OBJECTIVE
  To classify patients with nonmetastatic advanced gastric cancer who underwent D2-gastrectomy into prognostic groups based on peritoneal and systemic recurrence risks.
  
  
  METHODS
  Between 2004 and 2007, 1,090 patients with T3-4 or N+ gastric cancer were identified from our registry. Recurrence rates were estimated using a competing-risk analysis. Different prognostic groups were defined using recursive partitioning analysis (RPA).
  
  
  RESULTS
  Median follow-up was 7 years. In the RPA-model for peritoneal recurrence risk, the initial node was split by T stage, indicating that differences between patients with T1-3 and T4 cancer were the greatest. The 5-year peritoneal recurrence rates for patients with T4 (n = 627) and T1-3 (n = 463) disease were 34.3% and 9.1%, respectively. N stage and neural invasion had an additive impact on high-risk patients. The RPA model for systemic relapse incorporated N stage alone and gave two terminal nodes: N0-2 (n = 721) and N3 (n = 369). The 5-year cumulative incidences were 7.7% and 24.5%, respectively.
  
  
  CONCLUSIONS
  We proposed risk stratification models of peritoneal and systemic recurrence in patients undergoing D2-gastrectomy. This classification could be used for stratification protocols in future studies evaluating adjuvant therapies such as preoperative chemoradiotherapy. J. Surg. Oncol. 2016;114:859-864. © 2016 2016 Wiley Periodicals, Inc.
authors: Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
authors: Jee Suk
authors: JS
authors: Chang
authors: Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.|Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea.
authors: Kyung Hwan
authors: KH
authors: Kim
authors: Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
authors: Ki Chang
authors: KC
authors: Keum
authors: Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
authors: Sung Hoon
authors: SH
authors: Noh
authors: Department of Radiology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
authors: Joon Seok
authors: JS
authors: Lim
authors: Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
authors: Hyo Song
authors: HS
authors: Kim
authors: Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
authors: Sun Young
authors: SY
authors: Rha
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors: Yong Chan
authors: YC
authors: Lee
authors: Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea. WJHYUNG@yuhs.ac.
authors: Woo Jin
authors: WJ
authors: Hyung
authors: Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea. mdgold@yuhs.ac.
authors: Woong Sub
authors: WS
authors: Koom
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000517:prevention & control / Q000556:secondary*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000175:diagnosis / Q000517:prevention & control / Q000556:secondary*; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery* / Q000628:therapy
keywords: gastrectomy; gastric cancer; recurrence; recursive partition analysis; survival