Abstract
Considered from the viewpoint that gastric cancer has late recurrence, the late recurrence, i.e. recurrence from 5 years after resection of gastric cancer, means that gastric cancer cells are in an advantageous situation allowing 5 years of survival at the time of surgical operation and that they have concurrently risk factors developing recurrence. Elucidating the factors which are considered to affect late recurrence is important in establishing the surgical procedure and adjuvant immuno- and chemotherapy for improving the prognosis after resection of gastric cancer. Using 740 cases with curative resection of gastric cancer at this department (March, 1956-December, 1981), we compared cases of late recurrence with the control cases, that is, cases of early recurrence that had the recurrence not more than 2 years after resection and cases of middle-period recurrence, 2-5 years after resection, and made a clinicopathological study. Recurrence after curative resection was found in 261 cases, the breakdown of which: 157 cases (60.1%) of early recurrence, 74 cases (28.4%) of middle-period recurrence and 30 (11.5%) of late recurrence. Late recurrence corresponded to 4.1% of the cases with curative resection. The number of cases of recurrence by the number of years elapsed after curative resection reached 60% of all cases of recurrence up to 2 years after resection, gradually decrease thereafter and was only 1 from 10 years after resection. Cases of recurrence up to 2 years were found many in cases with relative curative resection and cases of recurrence from 3 years were found many in cases with absolute curative resection. As to 10 factors condidered to aftect prognosis after resection [location of cancerous lesion, macroscopic type, size (major diameter), depth of invasion, histologic type, lymph invasion, vascular invasion, lymph node metastasis, infiltrative growth (INF), histologic stage], statistical analyses and comparative studies were made in 3 groups, namely, the early recurrence case, the middle-period recurrence case and late recurrence case. The results showed the incidence of late recurrence to be high in M and A of location of cancerous lesion, 0 and 5 type of macroscopic type, m, sm and pm of depth of invasion, v (-), n (-), INFα, and stage I . These characteristics were similar to those of cases with 10-year survival after curative resection of progressive gastric cancer at this department. Cases of late recurrence are in an advantageous situation that allows a relatively good prognosis. However, they have a slightly disadvantageous risk factor compared with cases with 10-year survival. Presumably, that is why they has recurrence from 5 years after resection. Furthermore, a difference in the time of recurrence as viewed by the absolute curative resection and relative curative resection was studied in relation to 3 factors, namely, depth of invasion [ps (-), ps (+) ], lymph node metastasis (n0+n1, n2+n3) and stage [I + II, III+IV] . As a result, it was made clear that is a tendency for the frequency of absolute curative resection to increase and for the frequency of relative curative curative resection to decrease with a shift from early recurrence to late recurrence in each factor and that s-factor more influences on the prognosis (recurrence) than n-factor. As for the site of recurrence (total number inclusive of main and sub-site of recurrence) in late recurrence, the recurrence was found the most in the peritoneum 12 cases (24.5 %) and lymph nodes 11 (22.4 %), followed by the liver 8 cases, bones 6 cases, subhepatic space 4 cases, remnant stomach 3 cases and lungs 2 cases. In any case, late recurrence is characterized mainly by the low resicual rate of cancer at the time that surgical operation has been performed.
