Clinicopathological analysis for recurrence of early gastric cancer

Background: Although the prognosis of early gastric cancer (EGC) is considered to be satisfactory, some patients experience disease recurrence after curative resection. This study was aimed at evaluating the recurrence rate, the recurrence patterns and the prognostic factors for recurrence of EGC as well as treatment results after recurrences. Methods: We investigated follow-up records of 1452 EGC patients on whom curative operations were performed at Seoul National University Hospital from 1986 to 1995 with special reference to cancer recurrence. Results: Twenty-one patients showed recurrences with a 1.5% 5-year cumulative recurrence rate. Four cases were locoregional recurrences, two were peritoneal recurrences, nine were distant recurrences and six were mixed type recurrences. The 5-year survival rates of T1NO, T1N1, T1N2 and T1N3 were 99.3, 96.8, 72.7 and 0%, respectively (P < 0.001). Multivariate analysis revealed a significantly high correlation between positive lymph node metastasis and recurrence (P < 0.001). Median survival after recurrence of EGC was 4.3 months. Median survival after recurrence was 5.8 months after chemotherapy and 3.1 months after conservative management (P = 0.69). Conclusion: Although the recurrence of EGC is very rare in general, EGC with lymph node metastasis has a higher possibility of recurring, especially with >6 positive lymph nodes. Even after curative resection of EGC, patients with EGC with >6 positive lymph nodes should be closely followed and be considered as candidates for adjuvant treatment.