Fattori predittivi di ripresa neoplastica in pazienti sottoposti a trattamento chirurgico curativo per cancro gastrico = [Predictive factors of neoplastic recurrence in patients submitted to curative surgical treatment for gastric cancer]

Aim. Gastric cancer is the fifth most common cause of tumor–related death in Western countries. Surgery, is the only effective treatment but only 50-60% of patients can receive a “curative” treatment (without microscopic or macroscopic residual tumor) and in 2/3 of these patients a neoplastic recurrence will occur. At present, no effective therapy exists for “recurrent” gastric cancer and for this reason the estimation of the risk of recurrence in individual patients may be relevant in clinical practice, to apply adjuvant therapies or to plan an adequate follow-up program. The aim of this study is to characterize all those factors influencing the risk of recurrence after radical surgery for gastric cancer, considering tumor – related and patient – related variables. Methods. This study includes 48 patients who underwent curative surgery for gastric cancer between January 1998 and December 2002 at Department of General , Geriatric Surgery and Diagnostic and Operative Endoscopy of the University “Federico II” in Naples. All patients were followed up with a standard protocol for 5 years. Variables considered at statistical analysis for the risk of recurrence were : age, sex, staging, linfonodal ratio, tumoral size, tumoral location, Lauren histotype and grading. Results. Recurrence occurred in 42% of patients (n=20). Univariate analysis identified these variables with a significant effect on the recurrence risk : age ≥60 (OR 3.40; p=0,059), stage III (OR 3.54; p=0,029), LNR ≥20% (OR 2.74; p=0,086), tumoral size ≥4 cm (OR 2.25; p=0,1), location at superior third (OR 15.47; p=0,012) and middle third (OR 10.37; p=0,008). Conclusion. To improve the post-surgical prognostic stratification it is necessary to consider tumor – related (stage, location, size, linfonodal involvement) and patient – related (age) factors. In our study we have identified the characteristics of a “high-risk” patient for recurrence : age ≥60 with proximal neoplasms of large size, stage III and LNR ≥20%.High – risk patients should receive a more aggressive adjuvant therapy and an adequate follow-up program.