Introduction
Methods
Study population
Data collection
Statistical analysis
Results
Patients
Characteristics | All patients | Recurrence | No recurrence | P value | |||
---|---|---|---|---|---|---|---|
N
| %a |
N
| %b |
N
| %b | ||
408 | 100 | 150 | 36.8 | 258 | 63.2 | ||
Age | 0.1107 | ||||||
≥ 70 years | 143 | 35.1 | 43 | 30.1 | 100 | 69.9 | |
60–69 years | 145 | 35.5 | 57 | 39.3 | 88 | 60.7 | |
< 60 years | 120 | 29.4 | 50 | 41.7 | 70 | 58.3 | |
Sex | 0.6187 | ||||||
Male | 262 | 64.2 | 94 | 35.9 | 168 | 64.1 | |
Female | 146 | 35.8 | 56 | 38.4 | 90 | 61.6 | |
Comorbidities | < 0.0001 | ||||||
None | 100 | 24.51 | 52 | 52.0 | 48 | 48.0 | |
1 | 99 | 24.26 | 45 | 45.5 | 54 | 54.5 | |
2 or more | 100 | 24.51 | 41 | 41.0 | 59 | 59.0 | |
Unknown | 109 | 26.72 | 12 | 11.0 | 97 | 89.0 | |
Type of preoperative chemotherapy | 0.2389 | ||||||
Triplet chemotherapy | 311 | 76.2 | 118 | 37.9 | 193 | 62.1 | |
ECX/ECF |
201
|
49.3
|
79
|
39.3
|
122
|
60.7
| |
EOX/EOF |
93
|
22.8
|
34
|
36.6
|
59
|
63.4
| |
DOCCS |
16
|
3.9
|
4
|
25.0
|
12
|
75.0
| |
Other triplet chemotherapy |
1
|
0.3
|
1
|
100.0
|
0
|
0.0
| |
Doublet chemotherapy | 12 | 2.9 | 1 | 0.7 | 11 | 4.3 | |
CAP-/FOLFOX |
11
|
2.7
|
1
|
9.1
|
10
|
90.9
| |
Carboplatin + paclitaxel |
1
|
0.3
|
0
|
0.0
|
1
|
100.0
| |
Mono chemotherapy | 1 | 0.3 | 1 | 100.0 | 0 | 0.0 | |
Unknown | 84 | 20.6 | 30 | 35.7 | 54 | 64.3 | |
Postoperative therapy | 0.0828 | ||||||
None | 142 | 34.8 | 47 | 33.1 | 95 | 66.9 | |
Chemoradiotherapy | 61 | 15.0 | 30 | 49.2 | 31 | 50.8 | |
Chemotherapy | 205 | 50.3 | 73 | 35.6 | 132 | 64.4 | |
ECX/ECF |
93
|
45.4
|
34
|
36.6
|
59
|
63.4
| |
EOX/EOF |
48
|
23.4
|
17
|
35.4
|
31
|
35.4
| |
Other chemotherapy |
64
|
31.2
|
22
|
34.4
|
42
|
60.7
| |
Number of chemotherapy cycles | 0.8693 | ||||||
1 or 2 | 53 | 13.0 | 20 | 37.7 | 33 | 62.3 | |
3 | 106 | 26.0 | 40 | 37.7 | 66 | 62.3 | |
4 or 5 | 48 | 11.8 | 20 | 41.7 | 28 | 58.3 | |
6 or more | 115 | 28.2 | 38 | 33.0 | 77 | 77.0 | |
Unknown | 86 | 21.1 | 32 | 37.2 | 54 | 62.8 | |
ASA score | 0.0382 | ||||||
Class I | 38 | 9.3 | 11 | 28.9 | 27 | 71.1 | |
Class II | 241 | 59.1 | 87 | 36.1 | 154 | 63.9 | |
Class III | 72 | 17.7 | 22 | 30.6 | 50 | 69.4 | |
Unknown | 57 | 14.0 | 30 | 52.6 | 27 | 47.4 | |
Lauren’s classification | 0.0071 | ||||||
Diffuse | 189 | 46.3 | 86 | 45.5 | 103 | 54.5 | |
Intestinal | 154 | 37.8 | 43 | 27.9 | 111 | 72.1 | |
Mixed | 35 | 8.6 | 12 | 34.3 | 23 | 65.7 | |
Unknown | 30 | 7.4 | 9 | 30.0 | 21 | 70.0 | |
Tumor regression | 0.0004 | ||||||
Complete | 24 | 5.9 | 3 | 12.5 | 21 | 87.5 | |
Subtotal | 19 | 4.7 | 4 | 21.0 | 15 | 79.0 | |
Partial | 85 | 20.8 | 33 | 38.8 | 52 | 61.2 | |
None | 52 | 12.8 | 31 | 59.6 | 21 | 40.4 | |
Unknown | 228 | 55.9 | 79 | 34.7 | 149 | 65.4 | |
ypT stage | < 0.0001 | ||||||
T0 | 30 | 7.4 | 3 | 10.0 | 27 | 90.0 | |
T1 | 52 | 12.8 | 6 | 11.5 | 46 | 88.5 | |
T2 | 59 | 14.5 | 12 | 20.3 | 47 | 79.7 | |
T3 | 175 | 42.9 | 78 | 44.6 | 97 | 55.4 | |
T4 | 90 | 22.1 | 51 | 56.7 | 39 | 43.3 | |
TX | 2 | 0.5 | 0 | 0.0 | 2 | 100.0 | |
ypN stage | < 0.0001 | ||||||
N0 | 185 | 45.3 | 31 | 16.8 | 154 | 83.2 | |
N+ | 223 | 54.7 | 119 | 53.4 | 104 | 46.6 | |
Resected lymph nodes | 0.3550 | ||||||
< 15 | 89 | 21.81 | 29 | 32.6 | 60 | 67.4 | |
15 or more | 319 | 78.19 | 121 | 37.9 | 198 | 62.1 | |
Differentiation grade | 0.0805 | ||||||
Well/moderately | 52 | 12.8 | 13 | 25.0 | 39 | 75.0 | |
Poorly/undifferentiated | 204 | 50.0 | 84 | 41.2 | 120 | 58.8 | |
Unknown | 152 | 37.3 | 53 | 34.9 | 99 | 65.1 | |
Resection margin | < 0.0001 | ||||||
R0 | 346 | 84.8 | 112 | 32.4 | 234 | 67.6 | |
R1/R2 | 48 | 11.8 | 30 | 62.5 | 18 | 37.5 | |
Unknown | 14 | 3.4 | 8 | 57.1 | 6 | 42.9 | |
Tumor location | 0.0054 | ||||||
Cardia | 28 | 6.9 | 9 | 32.1 | 19 | 67.9 | |
Proximal/middle | 150 | 36.8 | 54 | 36.0 | 96 | 64.0 | |
Antrum | 110 | 27.0 | 28 | 25.5 | 82 | 74.5 | |
Pyloric | 23 | 5.6 | 10 | 43.5 | 13 | 56.5 | |
Other | 97 | 23.8 | 49 | 50.5 | 48 | 49.5 |
Follow-up and recurrence rates
Patterns of recurrence
Time interval until recurrence
Multivariable analyses to identify factors associated with recurrence
Characteristics | Eventsa | Univariable | Multivariable | ||||||
---|---|---|---|---|---|---|---|---|---|
HR | 95% CI | P value | HR | 95% CI | P value | ||||
Lower | Upper | Lower | Upper | ||||||
Age | |||||||||
≥ 70 years | 70 | Ref | Ref | ||||||
60–69 years | 70 | 0.95 | 0.68 | 1.32 | 0.740 | 1.01 | 0.70 | 1.45 | 0.965 |
< 60 years | 58 | 0.93 | 0.66 | 1.32 | 0.684 |
0.64
|
0.42
|
0.97
|
0.034
|
Sex | |||||||||
Male | 128 | Ref | Ref | ||||||
Female | 70 | 0.99 | 0.74 | 1.32 | 0.923 | 1.04 | 0.75 | 1.44 | 0.811 |
Comorbidities | |||||||||
None | 56 | Ref | – | ||||||
1 | 53 | 0.95 | 0.65 | 1.38 | 0.780 | – | |||
2 or more | 62 | 1.33 | 0.92 | 1.91 | 0.126 | – | |||
Unknown | 27 | 0.36 | 0.23 | 0.57 |
<
0.001
| – | |||
Type of preoperative chemotherapy | |||||||||
Triplet chemotherapy | |||||||||
ECX/ECF | 94 | Ref | Ref | ||||||
EOX/EOF | 48 | 1.24 | 0.87 | 1.75 | 0.233 | 1.26 | 0.86 | 1.85 | 0.242 |
Other triplet chemotherapy | 8 | 0.86 | 0.42 | 1.78 | 0.692 | 1.20 | 0.53 | 2.73 | 0.664 |
Mono/doublet chemotherapy | 8 |
2.07
|
1.00
|
4.26
|
0.049
| 1.62 | 0.73 | 3.60 | 0.241 |
Unknown | 40 | 0.94 | 0.65 | 1.36 | 0.122 | 1.64 | 0.26 | 10.40 | 0.599 |
Number of chemotherapy cycles | |||||||||
1 or 2 | 53 | 1.43 | 0.88 | 2.33 | 0.154 | 1.48 | 0.87 | 2.54 | 0.152 |
3 | 106 |
2.04
|
1.39
|
2.99
|
<
0.001
|
3.04
|
1.99
|
4.63
|
<
0.001
|
4 or 5 | 48 | 1.21 | 0.73 | 2.00 | 0.459 | 1.16 | 0.67 | 2.02 | 0.602 |
6 or more | 115 | Ref | Ref | ||||||
Unknown | 86 | 1.21 | 0.79 | 1.84 | 0.383 | 0.88 | 0.14 | 5.41 | 0.891 |
Adjuvant (postoperative) treatment | |||||||||
No adjuvant treatment | 142 |
1.76
|
1.29
|
2.39
|
<
0.001
| – | |||
Chemotherapy | 205 | Ref | – | ||||||
Chemoradiation | 61 | 1.44 | 0.97 | 2.14 | 0.073 | – | |||
ASA score | |||||||||
Class I | 12 | 0.59 | 0.32 | 1.06 | 0.078 | 0.73 | 0.39 | 1.38 | 0.332 |
Class II | 112 | Ref | Ref | ||||||
Class III | 37 | 1.25 | 0.86 | 1.81 | 0.246 | 1.13 | 0.75 | 1.71 | 0.566 |
Unknown | 37 |
1.75
|
1.20
|
2.54
|
0.003
|
2.32
|
1.51
|
3.57
|
<
0.001
|
Lauren’s classification | |||||||||
Intestinal | 106 | Ref | Ref | ||||||
Diffuse | 60 |
1.65
|
1.20
|
2.26
|
0.002
|
1.60
|
1.09
|
2.35
|
0.018
|
Mixed | 17 | 1.25 | 0.73 | 2.14 | 0.417 | 1.03 | 0.58 | 1.85 | 0.914 |
Unknown | 15 | 1.57 | 0.89 | 2.77 | 0.117 | 1.57 | 0.84 | 2.91 | 0.156 |
Tumor regression | |||||||||
Complete/subtotal | 8 | Ref | Ref | ||||||
Partial/none | 81 |
4.06
|
1.96
|
8.40
|
<
0.001
|
2.63
|
1.22
|
5.64
|
0.013
|
Unknown | 109 |
2.64
|
1.29
|
5.40
|
0.008
| 2.08 | 0.96 | 4.50 | 0.062 |
ypT stadium | |||||||||
T0–2, X | 31 | Ref | – | ||||||
T3 | 98 |
3.32
|
2.21
|
4.98
|
<
0.001
| – | |||
T4 | 69 |
6.07
|
3.96
|
9.31
|
<
0.001
| – | |||
ypN stadium | |||||||||
N0 | 46 | Ref | Ref | ||||||
N+ | 152 |
4.38
|
3.13
|
6.12
|
<
0.001
|
4.92
|
3.35
|
7.24
|
<
0.001
|
Number of resected lymph nodes | |||||||||
< 15 | 47 | 1.08 | 0.78 | 1.50 | 0.651 |
1.64
|
1.14
|
2.37
|
0.008
|
15 or more | 151 | Ref | Ref | ||||||
Resection margin | |||||||||
R0 | 147 | Ref | Ref | ||||||
R1/R2 | 40 |
3.10
|
2.18
|
4.40
|
<
0.001
|
1.52
|
1.02
|
2.26
|
0.041
|
Unknown | 11 |
3.61
|
1.95
|
6.69
|
<
0.001
| 1.73 | 0.88 | 3.40 | 0.110 |
Differentiation grade | |||||||||
Well/moderately | 19 |
0.60
|
0.37
|
0.98
|
0.042
| 0.67 | 0.39 | 1.17 | 0.156 |
Poorly/undifferentiated | 109 | Ref | Ref | ||||||
Unknown | 70 | 0.79 | 0.58 | 1.06 | 0.117 | 0.83 | 0.60 | 1.14 | 0.250 |
Tumor location | |||||||||
Cardia | 14 | 1.22 | 0.69 | 2.17 | 0.500 | 1.27 | 0.67 | 2.40 | 0.464 |
Proximal/middle | 69 | Ref | Ref | ||||||
Antrum | 41 | 0.79 | 0.53 | 1.16 | 0.220 | 0.74 | 0.48 | 1.14 | 0.177 |
Pyloric | 12 | 1.22 | 0.66 | 2.26 | 0.523 | 0.86 | 0.44 | 1.69 | 0.662 |
Other | 62 |
1.69
|
1.20
|
2.38
|
0.003
| 1.41 | 0.96 | 2.06 | 0.079 |