title: Lauren Histologic Type Is the Most Important Factor Associated With Pattern of Recurrence Following Resection of Gastric Adenocarcinoma.
abstract: OBJECTIVE
  To examine sites of initial recurrence in patients after resection of gastric and gastroesophageal junction Siewert II/III adenocarcinoma (GA).
  
  
  BACKGROUND
  There are few recent studies on recurrence for Western patients following potentially curative resection of GA.
  
  
  METHODS
  A review of a prospectively maintained, single institution database was performed. Clinicopathologic factors, site(s) of initial recurrence, disease-free survival, and overall survival were examined.
  
  
  RESULTS
  From January 2000 to June 2010, 957 patients underwent potentially curative resection for GA, 435 patients (46%) had recurrent disease, and complete data on recurrence site(s) could be obtained in 386 patients. Tumors were Lauren intestinal type in 206 (53%) and diffuse or mixed-type in 180 (47%). Median time to recurrence was 12 months and 75% of recurrences occurred within 2 years. There was a significant difference in pattern of initial recurrence between the intestinal and diffuse/mixed cohorts (P < 0.001). For intestinal tumors, distant metastasis was the most common site (54%), followed by locoregional (20%), peritoneal (15%), and multifocal (11%). For diffuse/mixed tumors, peritoneal recurrence was the most common (37%), followed by distant (32%), locoregional (22%), and multifocal (9%). On multivariate analysis, Lauren histologic type was the only significant factor that was associated with both peritoneal recurrence (diffuse, hazard ratio 2.22, confidence interval 1.38-3.94) and distant recurrence (intestinal, hazard ratio 1.888, confidence interval 1.202-2.966). After recurrence, median overall survival was only 8.4 months.
  
  
  CONCLUSIONS
  In GA patients who recur after resection, patterns of recurrence vary significantly based on Lauren histologic type.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.|Department of Surgery, Sungkyunkwan University, Samsung Medical Center, Seoul, South Korea.
authors.forename: Jun H
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Chang
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Changhwan
authors.initials: C
authors.lastname: Yoon
authors.affiliation: Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Laura H
authors.initials: LH
authors.lastname: Tang
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Vivian E
authors.initials: VE
authors.lastname: Strong
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Sam S
authors.initials: SS
authors.lastname: Yoon
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D004943:Esophagogastric Junction; D005260:Female; D005743:Gastrectomy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology*; D009367:Neoplasm Staging / Q000379:methods*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D055815:Young Adult