NEW YORK (Reuters Health) - Among patients with lymph-node-negative gastric adenocarcinoma, those with T-stage 3 or higher have a significantly shorter time to recurrence, according to a recent study.
The findings, published online January 20 in Annals of Surgery, also showed that signet ring histology, lymphovascular invasion, and T-stage 3 or higher were associated with a decreased overall survival in patients with lymph-node-negative gastric adenocarcinoma.
"These high-risk patients may benefit from adjuvant therapy and closer surveillance," Dr. Ryan Fields, assistant professor of hepatobiliary, pancreatic, gastrointestinal, and oncologic surgery at Washington University School of Medicine in St. Louis, wrote in an email to Reuters Health. "This may include more frequent post-treatment imaging and clinical evaluations."
Research clearly has established that lymph node status is among the most important predictors of recurrence and survival following resection of gastric cancer. However, a subgroup of lymph node negative patients experiences a higher risk of recurrence, as well as decreased survival.
Dr. Linda Jin and colleagues from the seven institutions forming the United States Gastric Cancer Collaborative, designed this study to identify the pathologic features predictive of recurrence and decreased survival in patients with node-negative disease.
Included in the study were 805 patients who underwent resection for gastric adenocarcinoma at one of the seven institutions participating in the collaborative between 2000 and 2012. Of the total, 317 (39%) patients had lymph-node-negative disease and 54 (17%) patients in this sub-cohort had a recurrence with a median follow-up time of 68 months.
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"For patients who undergo upfront surgery, adjuvant chemoradiation or chemotherapy are recommendations of the National Comprehensive Cancer Network for T3-4Nany tumors," Dr. Geoffrey Ku, a physician at Memorial Sloan Kettering Cancer Center in New York City, who was not involved in the study, wrote in an email to Reuters Health.
"In this regard, the observation that T3-4N0 tumors are associated with a higher risk of recurrence would support the NCCN guidelines," he added.
SOURCE: http://bit.ly/1vqIIiJ
Ann Surg 2015.
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