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Symptomatic Recurrence and Survival Outcomes After Curative Treatment of Gastric Cancer: Does Intensive Follow-up Evaluation Improve Survival?

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Intensive surveillance after treatment of gastric cancer patients with curative intent may lead to an earlier diagnosis of disease recurrence, but its impact on survival is uncertain. This study aimed to evaluate whether early diagnosis of disease recurrence among asymptomatic patients was associated with long-term survival.

Methods

This retrospective study analyzed patients with stages 1 to 3C gastric adenocarcinoma treated between 1999 and 2018. All recurrence events were classified as symptomatic or asymptomatic (detected by follow-up tests), and their clinicopathologic characteristics, patterns of recurrence, and survival were analyzed.

Results

The cohort consisted of 669 patients treated with a total gastrectomy in 48.6% and a D2-lymphadenectomy in 88.8% of the cases. Most of the tumors were pT3-4 (46.5%), with 45.5% involving lymph node metastases and 42.3% manifesting a diffuse histology. During a median follow-up period of 80.1 months (95% confidence interval [CI], 75.3–84.8 months), 166 patients had recurrences (24.8%), 65.7% of which were symptomatic. The peritoneum was the main site of recurrence (37.2%), and peritoneal recurrence was associated with worse overall survival (OS) (hazard ratio, 1.69; 95%CI, 1.2–2.37). The median disease-free, post-recurrence survival, and OS periods in the asymptomatic and symptomatic groups were respectively 13.4 versus 17.2 months (p = 0.04), 11.9 versus 4.7 months (p < 0.001), and 29.9 versus 26.4 months (p = 0.21). When OS was analyzed among the patients with non-peritoneal recurrence, no difference was observed between the two groups (31.3 vs 31.1 months; p = 0.46).

Conclusion

Early diagnosis of asymptomatic disease recurrence did not affect the OS of the gastric cancer patients treated with curative intent. The use of intensive surveillance strategies in this scenario still requires further evidence.

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Acknowledgments

This study was founded in part by a Research Training Award for Cancer Prevention Post-graduate Training Program in Integrative Epidemiology from the Cancer Prevention & Research Institute of Texas, Grant No. RP160097 (PI: M. Spitz).

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Authors and Affiliations

  1. Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil

    Thiago Pereira Diniz MD, Wilson L. da Costa Jr MD, PhD, MPH, Camila Couto Gomes MD, Silvio Melo Torres MD, Héber S. C. Ribeiro MD, PhD, Alessandro L. Diniz MD, André Luís de Godoy MD, Igor Correia de Farias MD & Felipe J. F. Coimbra MD, PhD

  2. Department of Medicine, Epidemiology, and Population Sciences, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA

    Wilson L. da Costa Jr MD, PhD, MPH

  3. Department of Clinical Oncology, A. C. Camargo Cancer Center, São Paulo, Brazil

    Victor Hugo F. de Jesus MD & Tiago C. Felismino MD

  4. Medical Genomics Laboratory, CIPE/A.C. Camargo Cancer Center, São Paulo, Brazil

    Emmanuel Dias-Neto MD, PhD

  5. Cancer Epidemiology and Statistics Group, International Research Center, A. C. Camargo Cancer Center, São Paulo, SP, Brazil

    Maria Paula Curado MD, PhD

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  1. Thiago Pereira Diniz MD
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Correspondence to Felipe J. F. Coimbra MD, PhD.

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Diniz, T.P., da Costa, W.L., Gomes, C.C. et al. Symptomatic Recurrence and Survival Outcomes After Curative Treatment of Gastric Cancer: Does Intensive Follow-up Evaluation Improve Survival?. Ann Surg Oncol 29, 274–284 (2022). https://doi.org/10.1245/s10434-021-10724-5

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