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10.1245/s10434-007-9479-4
Annals of Surgical Oncology 14:2730-2737 (2007)
© 2007 Society of Surgical Oncology
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Original Article

Changing Patterns of Prognosticators During 15-Year Follow-Up of Advanced Gastric Cancer after Radical Gastrectomy and Adjuvant Chemotherapy: A 15-Year Follow-Up Study at a Single Korean Institute

Yong Wha Moon, MD1,2,3, Hei-Cheul Jeung, MD, PhD1,2, Sun Young Rha, MD, PhD1,2,5, Nae Choon Yoo, MD, PhD1,2,3, Jae Kyung Roh, MD, PhD1,2,3,5, Sung Hoon Noh, MD, PhD2,4,5, Byung Soo Kim, MD, PhD1,2 and Hyun Cheol Chung, MD, PhD1,2,3,5

1 Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
2 Cancer Metastasis Research Center, Yonsei University College of Medicine, Seoul, Korea
3 Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
4 Department of General Surgery, Yonsei University College of Medicine, Seoul, Korea
5 Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea

Correspondence: Address correspondence and reprint requests to: Hyun Cheol Chung, MD, PhD; E-mail: unchung8{at}yumc.yonsei.ac.kr

Background: We evaluated the long-term natural history of gastric cancer after radical gastrectomy and adjuvant chemotherapy through a 15-year follow-up study at a single institute.

Methods: Five hundred patients with advanced gastric adenocarcinoma who received radical gastrectomy and adjuvant chemotherapy were included in this long-term follow-up study. Patients were evaluated by imaging studies and upper gastrointestinal series or endoscopy every 6 months until the 10th year after surgery. Since then, the patients have been followed yearly in the same manner.

Results: The median follow-up period was 190.5 months. The recurrence rate in 5-year survivors was 10.8%. The dominant recurrence pattern was peritoneal carcinomatosis within 5 years and distant metastasis after 5 years post gastrectomy. Tumor stage was a clear-cut prognosticator within 5 years post gastrectomy, but was no longer informative in 5–10 years. At this period, only stage IV (IB–IIIB vs IVM0) was a significantly poor prognosticator. After 10 years, second primary cancer (seven cases) became as important an issue as recurrence of primary gastric cancer (six cases).

Conclusions: In patients with gastric carcinoma treated with radical gastrectomy and adjuvant chemotherapy, late recurrence after 5 years post gastrectomy was not rare. Prognosticators were varied depending on the length of time after surgery. Tumor factors including stage were prognosticators within 5 years post gastrectomy, but tumor factors except stage IV had no prognostic value after 5 years. In the 5–10 years post gastrectomy, only stage IV (IB–IIIB vs IVM0) was a poor prognosticator. Also, after 10 years, there were no prognosticators.

Key Words: Gastric carcinoma • Gastrectomy • Adjuvant chemotherapy • Long-term survivor • Prognosis






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