Reappraise role of lymph node status in patterns of recurrence following curative resection of gastric adenocarcinoma

Objective: To examine the association between lymph node status and recurrence patterns in completely resected gastric adenocarcinoma.Methods: We retrospectively assessed 1,694 patients who underwent curative gastrectomy from January 2010 to August 2014. Patients stratified according to lymph node status and recurrence patterns among different subgroups were compared.Results: Of all, 517（30.5%） patients developed recurrent disease, and complete data of recurrence could be obtained in 493（95.4%） patients. For pN0 patients, the patterns of recurrence were different according to p T stage: locoregional recurrence was most common in patients with p T1-2 disease（57.1%）, distant recurrence was most common in patients with p T3 disease（57.1%）, and peritoneal recurrence was most common in patients with p T4 a disease（66.7%）. For pN+ patients, distant metastasis was most common pattern irrespective of p T stage. The site-specific trend of recurrence showed that locoregional recurrence increased within 5 years in patients with pN0-2 disease but plateaued 3 years after surgery in patients with p N3 disease. Time to recurrence was significantly longer for the pN0 patients compared with the pN+ patients（median: 25 vs. 16 months, P=0.001）.Moreover, post-recurrence survival was significantly better for the pN0 patients than for the pN+ patients（median:12 vs. 6 months, P<0.001）, especially in patients with non-peritoneal recurrence, late recurrence, single recurrence,and receipt of potential curative treatment.Conclusions: Among clinicopathologic factors, lymph node status is the most important factor associated with recurrence patterns after curative gastrectomy. Lymph node status may be used as an adjunct in clinical decisionmaking about postoperative therapeutic and follow-up strategies.