Pathological serosa and node-based classification accurately predicts gastric cancer recurrence risk and outcome, and determines potential and limitation of a Japanese-style extensive surgery for Western patients: a prospective with quality control 10-year follow-up study

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dc.contributor.authorRoukos, D. H.en
dc.contributor.authorLorenz, M.en
dc.contributor.authorKarakostas, K.en
dc.contributor.authorParaschou, P.en
dc.contributor.authorBatsis, C.en
dc.contributor.authorKappas, A. M.en
dc.date.accessioned2015-11-24T18:59:57Z
dc.date.available2015-11-24T18:59:57Z
dc.identifier.issn0007-0920-
dc.identifier.urihttps://olympias.lib.uoi.gr/jspui/handle/123456789/19447
dc.rightsDefault Licence-
dc.subjectAdulten
dc.subjectAgeden
dc.subjectAged, 80 and overen
dc.subjectFemaleen
dc.subjectFollow-Up Studiesen
dc.subjectGastrectomy/*methodsen
dc.subjectHumansen
dc.subjectLymph Nodes/*pathologyen
dc.subjectLymphatic Metastasisen
dc.subjectMaleen
dc.subjectMiddle Ageden
dc.subjectNeoplasm Invasivenessen
dc.subject*Neoplasm Recurrence, Localen
dc.subject*Neoplasm Stagingen
dc.subjectPredictive Value of Testsen
dc.subjectPrognosisen
dc.subjectProspective Studiesen
dc.subjectRisk Assessmenten
dc.subjectSensitivity and Specificityen
dc.subjectStomach Neoplasms/*pathology/*surgeryen
dc.subjectTreatment Outcomeen
dc.titlePathological serosa and node-based classification accurately predicts gastric cancer recurrence risk and outcome, and determines potential and limitation of a Japanese-style extensive surgery for Western patients: a prospective with quality control 10-year follow-up studyen
heal.abstractUICC classification accurately predicts overall survival but not recurrence-risk. We report here data of overall and first site-specific recurrence following curative surgery useful for the development of recurrence-oriented preventive target therapies. Patients who underwent resection for gastric cancer were stratified according to curability of surgery [curative (R0) vs non-curative resection], extent of surgery [limited (D1) vs extended (D2) node dissection] and pathological nodal/serosal status. The intent-to-treat principle, log-rank test and Cox regression analysis were used for statistical analysis of time-to-event (recurrence, death) endpoints. Curative resection only produced a chance of cure whereas survival was very poor following non-curative resection (P < 0.0001). For D2 R0 subgroup of patients, a pathological serosa and a node state-based classification into three groups, proved to be of clinical implication. Risk of recurrence after a median follow-up of 92 months was low among patients with both serosa and node-negative cancer (first group; 11%), moderate among those with either serosa or node-positive cancer (second group; 53%) and very high among those with both serosa and node-positive cancer (third group; 83%). In multivariate analysis, the relative risks of recurrence and death from gastric cancer among patients in the second and third groups, as compared to those in the first, were 7.07 (95% CI, 2.36-21.17; P = 0.0002) and 16.19 (95% CI, 5.76-45.54; P < 0.0001) respectively. First site-specific recurrence analysis revealed: low rate of loco-regional recurrence alone (12%), serosa state determinant factor of the site-recurrence (peritoneal for serosa-positive and haematogenous for serosa-negative cancers) and dramatic increase of all types of recurrence by the presence of nodal metastases. Our findings demonstrate that a pathological serosa- and node-based classification is very simple and predicts accurately site-specific recurrence-risks. Furthermore they reveal that risk of recurrence following curative D2 surgery alone is low for serosa- and node-negative cancers, but very high in serosa- and node-positive cancers suggesting the need for new therapeutic strategies in this subgroup of patients.en
heal.accesscampus-
heal.fullTextAvailabilityTRUE-
heal.identifier.primary10.1054/bjoc.2001.1720-
heal.identifier.secondaryhttp://www.ncbi.nlm.nih.gov/pubmed/11401312-
heal.identifier.secondaryhttp://www.nature.com/bjc/journal/v84/n12/pdf/6691720a.pdf-
heal.journalNameBr J Canceren
heal.journalTypepeer-reviewed-
heal.languageen-
heal.publicationDate2001-
heal.recordProviderΠανεπιστήμιο Ιωαννίνων. Σχολή Επιστημών Υγείας. Τμήμα Ιατρικήςel
heal.typejournalArticle-
heal.type.elΆρθρο Περιοδικούel
heal.type.enJournal articleen

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