Objective To discuss the present status and progress of clinical research on recurrence of gastric cancer after surgery, including patterns, clinicopathologic factors, prognosis, detection, diagnosis, prevention, and ...Objective To discuss the present status and progress of clinical research on recurrence of gastric cancer after surgery, including patterns, clinicopathologic factors, prognosis, detection, diagnosis, prevention, and treatment strategies. Data sources The data used in this review were mainly from PubMed articles published in English from 2000 to August 2011. The search terms were ＂gastric cancer＂ and ＂recurrence＂. Study selection Articles were selected if they involved clinicopathologic factors, detection methods, and treatment strategies of recurrence of gastric cancer. Results Peritoneal recurrence is the most common pattern in recurrence of gastric cancer. The main risk factors for recurrence of gastric cancer are tumor stage, including depth of tumor invasion and lymph node metastasis, and Borrmann classification. The prognosis of patients with recurrence is very poor, especially patients with peritoneal recurrence. Systemic chemotherapy is still the main treatment method for patients with recurrent cancer. If complete resection can be accomplished, some benefits may be obtained from surgery for recurrence. However, standard treatment for patients with recurrence has not yet been established. Conclusions Early detection and diagnosis of recurrence is quite crucial for treatment and prognosis. The optimal therapeutic strategy for recurrence should be based on a multidisciplinary assessment and the patient＇s individual state and should involve combined therapy.展开更多
Background The prognosis for patients with gastric cancer and synchronous liver metastases is very poor.However,a standard therapeutic strategy has not been well established.The clinical benefit and prognostic factors...Background The prognosis for patients with gastric cancer and synchronous liver metastases is very poor.However,a standard therapeutic strategy has not been well established.The clinical benefit and prognostic factors after hepatic surgical treatment for liver metastases from gastric cancer remain controversial.Methods Records of 105 patients who underwent gastrectomy regardless of hepatic surgical treatment for gastric cancer with synchronous liver-only metastases in our center between 1995 and 2010 were retrospectively reviewed.Results The overall survival rate for the 105 patients was 42.1%,17.2%,and 10.6% at 1,2,and 3 years,respectively,with a median survival time of 11 months.Multivariate survival analysis revealed that the extent of lymphadenectomy （D） （P 〈0.001）,lymph node metastases （P 〈0.001）,extent of liver metastases （H） （P=0.008）,and lymphovascular invasion （P=-0.002） were significant independent prognostic factors for survival.Among patients who underwent D2 lymphadenectomy,those who underwent hepatic surgical treatment had a significantly improved survival compared with those who underwent gastrectomy alone （median survival,24 vs.12 months; P 〈0.001）.However,hepatic surgical treatment was not a prognostic factor for patients who underwent D1 lymphadenectomy （median survival,8 vs.8 months;P=0.495）.For the 35 patients who underwent gastrectomy plus hepatic surgical treatment,D2 lymphadenectomy （P 〈0.001）,lymph node metastases （P=-0.015）,and extent of liver metastases （H1 vs.H2 and H3） （P=-0.017） were independent significant prognostic factors for survival.Conclusions D2 lymphadenectomy plus hepatic surgical treatment may provide hope for long-term survival of judiciously selected patients with hepatic metastases from gastric cancer.Patients with a low degree of lymph node metastases and H1 liver metastases would make the most appropriate candidates.However,if D2 dissection cannot be achieved,hepatic surgical treatment is not recommended.展开更多
基金This study was supported by the National Natural Science Foundation of China （No. 81172368） and the Capital Clinical Application Research Foundation （No. ZI 11107058811047）.
文摘Objective To discuss the present status and progress of clinical research on recurrence of gastric cancer after surgery, including patterns, clinicopathologic factors, prognosis, detection, diagnosis, prevention, and treatment strategies. Data sources The data used in this review were mainly from PubMed articles published in English from 2000 to August 2011. The search terms were ＂gastric cancer＂ and ＂recurrence＂. Study selection Articles were selected if they involved clinicopathologic factors, detection methods, and treatment strategies of recurrence of gastric cancer. Results Peritoneal recurrence is the most common pattern in recurrence of gastric cancer. The main risk factors for recurrence of gastric cancer are tumor stage, including depth of tumor invasion and lymph node metastasis, and Borrmann classification. The prognosis of patients with recurrence is very poor, especially patients with peritoneal recurrence. Systemic chemotherapy is still the main treatment method for patients with recurrent cancer. If complete resection can be accomplished, some benefits may be obtained from surgery for recurrence. However, standard treatment for patients with recurrence has not yet been established. Conclusions Early detection and diagnosis of recurrence is quite crucial for treatment and prognosis. The optimal therapeutic strategy for recurrence should be based on a multidisciplinary assessment and the patient＇s individual state and should involve combined therapy.
文摘Background The prognosis for patients with gastric cancer and synchronous liver metastases is very poor.However,a standard therapeutic strategy has not been well established.The clinical benefit and prognostic factors after hepatic surgical treatment for liver metastases from gastric cancer remain controversial.Methods Records of 105 patients who underwent gastrectomy regardless of hepatic surgical treatment for gastric cancer with synchronous liver-only metastases in our center between 1995 and 2010 were retrospectively reviewed.Results The overall survival rate for the 105 patients was 42.1%,17.2%,and 10.6% at 1,2,and 3 years,respectively,with a median survival time of 11 months.Multivariate survival analysis revealed that the extent of lymphadenectomy （D） （P 〈0.001）,lymph node metastases （P 〈0.001）,extent of liver metastases （H） （P=0.008）,and lymphovascular invasion （P=-0.002） were significant independent prognostic factors for survival.Among patients who underwent D2 lymphadenectomy,those who underwent hepatic surgical treatment had a significantly improved survival compared with those who underwent gastrectomy alone （median survival,24 vs.12 months; P 〈0.001）.However,hepatic surgical treatment was not a prognostic factor for patients who underwent D1 lymphadenectomy （median survival,8 vs.8 months;P=0.495）.For the 35 patients who underwent gastrectomy plus hepatic surgical treatment,D2 lymphadenectomy （P 〈0.001）,lymph node metastases （P=-0.015）,and extent of liver metastases （H1 vs.H2 and H3） （P=-0.017） were independent significant prognostic factors for survival.Conclusions D2 lymphadenectomy plus hepatic surgical treatment may provide hope for long-term survival of judiciously selected patients with hepatic metastases from gastric cancer.Patients with a low degree of lymph node metastases and H1 liver metastases would make the most appropriate candidates.However,if D2 dissection cannot be achieved,hepatic surgical treatment is not recommended.
