근치적 위절제술 이후 재발암에 있어 추적검사 여부가 예후에 미치는 영향

Abstract

Background : Although routine post-operative surveillance after curative resection for gastric cancer is recommended, there is no consensus on the effect of optimal follow-up protocol. The aim of this study was to determine the role of post-operative surveillance as a prognostic factor in the patients with recurrent gastric cancer after curative resection of gastric cancer. Methods : 192 patients who had recurrence after curative resection of gastric cancer at the Hanyang University Hospital between January 2001 and June 2012 were retrospectively analyzed. We analyzed the clinicopathological factors and survival according to the presence or absence of symptoms after curative gastrectomy for gastric cancer. Results : 66 patients(34.4%) had symptomatic recurrences. The symptomatic recurrences had more undifferentiated gastric cancer. In addition, the types of recurrence were different. Peritoneal recurrences(60.6%) were dominant in the symptomatic recurrence, and locoregional recurrences(42.1%) were dominant in the asymptomatic recurrence. Median recurrence-free survival times were not different for both groups(P=0.507). However, median post-recurrence and overall survival times were longer in the asymptomatic group(P<0.001, P=0.022). Multivariate analysis showed the presence of symptoms(P=0.001) and perineural invasion(P=0.031) were independent poor prognostic factors for post-recurrence survival. In addition, the chemotherapy with or without surgery, and only curative surgery groups after recurrent gastric cancer were associated with a low hazard ratio compared to non-treatment group for post-recurrence survival. Conclusion : The patients with symptomatic gastric recurrences had poor post-operative survival compared to asymptomatic patients. The symptomatic recurrences had more aggressive tumor biology. Therefore, presence of the symptoms may be a good indicator to access biologic aggressiveness.