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Recursive partition analysis of peritoneal and systemic recurrence in patients with gastric cancer who underwent D2 gastrectomy: Implications for neoadjuvant therapy consideration

 Jee Suk Chang  ;  Kyung Hwan Kim  ;  Ki Chang Keum  ;  Sung Hoon Noh  ;  Joon Seok Lim  ;  Hyo Song Kim  ;  Sun Young Rha  ;  Yong Chan Lee  ;  Woo Jin Hyung  ;  Woong Sub Koom 
 Journal of Surgical Oncology, Vol.114(7) : 859-864, 2016 
Journal Title
 Journal of Surgical Oncology 
Issue Date
Adenocarcinoma/diagnosis ; Adenocarcinoma/prevention & control ; Adenocarcinoma/secondary* ; Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Gastrectomy*/methods ; Humans ; Lymph Node Excision ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Staging ; Peritoneal Neoplasms/diagnosis ; Peritoneal Neoplasms/prevention & control ; Peritoneal Neoplasms/secondary* ; Prognosis ; Retrospective Studies ; Stomach Neoplasms/pathology* ; Stomach Neoplasms/surgery* ; Stomach Neoplasms/therapy
gastrectomy ; gastric cancer ; recurrence ; recursive partition analysis ; survival
BACKGROUND AND OBJECTIVES: 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.
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
금기창(Keum, Ki Chang) ORCID logo https://orcid.org/0000-0003-4123-7998
금웅섭(Koom, Woong Sub) ORCID logo https://orcid.org/0000-0002-9435-7750
김효송(Kim, Hyo Song) ORCID logo https://orcid.org/0000-0002-0625-9828
노성훈(Noh, Sung Hoon) ORCID logo https://orcid.org/0000-0003-4386-6886
라선영(Rha, Sun Young) ORCID logo https://orcid.org/0000-0002-2512-4531
이용찬(Lee, Yong Chan)
임준석(Lim, Joon Seok) ORCID logo https://orcid.org/0000-0002-0334-5042
장지석(Chang, Jee Suk Paul) ORCID logo https://orcid.org/0000-0001-7685-3382
형우진(Hyung, Woo Jin) ORCID logo https://orcid.org/0000-0002-8593-9214
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