Risk Factors for Recurrence After Curative Conversion Surgery for Unresectable Gastric Cancer

Aim: To evaluate the recurrence risk after curative conversion surgery following chemotherapy for initially unresectable gastric cancer. Patients and Methods: We retrospectively analyzed clinicopathological and postoperative recurrence-free survival (RFS) data for 34 patients who underwent curative conversion surgery. Results: Recurrence was observed in 17 (50%) patients, with a median time to recurrence of 22 months (range=1-98 months). In nine (53%) patients with recurrence, the pattern was consistent with their initial metastatic disease. According to multivariate Cox regression analysis, initial clinical T4b disease (cT4b; odds ratio=6.44, 95% confidence interval=1.59-23.9; p=0.01) was the only significant independent risk factor affecting RFS. Pathological T4a or T4b disease was recorded in five-out of six (83%) patients with cT4b. Conclusion: Initial cT4b disease appears to predict recurrence in patients with initially unresectable gastric cancer treated with curative conversion surgery. Effective use of additional chemotherapy may be required for patients with this risk factor.