Lymph node status is among the most important predictors of recurrence after curative gastrectomy. However, the impact of lymph node status on recurrence patterns remains unclear. We aimed to analyse recurrence patterns in completely resected gastric cancer (GC) with negative (pN0) or positive (pN+) lymph nodes.
We retrospectively assessed 1694 patients who underwent curative gastrectomy from January 2010 to August 2014. Patients were divided into pN0(n=655) and pN+(n=1039) cohorts. Timing and site(s) of recurrence were examined.
Of all,517(30.5%) patients developed recurrent disease, and complete data on recurrence could be obtained in 493 patients.For the pN0 cohort, the patterns of recurrence were different according to pT stage: locoregional recurrence was the most common in patients with pT1-2 disease (57.1%), distant was the most common in patients with pT3 disease (57.1%), and peritoneal was the most common in patients with pT4a disease (66.7%). For the pN+ cohort, distant metastasis was the most common pattern irrespective of pT stage. The site-specific trend of recurrence showed that locoregional recurrence increased within 5 years in patients with pN0-2 disease but plateaued 3 years after surgery in patients with pN3 disease. Time to recurrence was significantly longer for the pN0 cohort compared with the pN+ cohort (median:25 vs 16 months=0.001). Moreover, post-recurrence survival was significantly better for the pN0 cohort than for the pN+ cohort (median:12 vs 6 months<0.001), especially in patients with non-peritoneal recurrence, late recurrence, single recurrence, and receipt of potential curative treatment.
There was a significant difference in recurrence patterns survival between node-negative and node-positive patients. For node-negative patients, follow-up strategies should be considered according to pathologic T stage, while the key to follow-up for node-positive patients is distant metastasis.
Scientific and Technological Innovation Joint Capital Projects of Fujian Province.
All authors have declared no conflicts of interest.