ImportanceConventional research and guidelines on postgastrectomy follow-up for gastric cancer often restrict their focus to the first 5 years after surgery.ObjectiveTo evaluate the association of extended regular follow-up after 5 years postgastrectomy in patients with gastric cancer with overall and postrecurrence survival rates.Design, Setting, and ParticipantsThis population-based, retrospective cohort study used Korean National Health Insurance claims data extracted between January 1, 2005, and December 31, 2014, with follow-up data examined until December 31, 2021. Patients without recurrence or other cancers at 5 years postgastrectomy were divided into 2 groups: those who had extended regular follow-up visits and those who did not. The data were analyzed between August 15 and November 15, 2023.ExposuresRegular follow-up vs irregular follow-up after 5 years postgastrectomy.Main Outcomes and MeasuresThe main outcome was whether extended regular follow-up after 5 years postgastrectomy was independently associated with overall and postrecurrence survival rates using Cox proportional hazards regression. Postrecurrence survival rates were also compared across different follow-up methods and intervals.ResultsA total of 40 468 patients with gastric cancer were included, with 14 294 in the regular follow-up group (mean [SD] age, 61.3 [11.7] years; 9669 male [67.8%]) and 26 174 in the irregular follow-up group (mean [SD] age, 58.1 [11.1] years; 18 007 male [68.8%]). Late recurrence or gastric remnant cancer (GRC) was identified in 3138 patients (7.8%), including 1610 of 40 468 patients (4.0%) between 5 and 10 years postgastrectomy and 1528 of 16 287 (9.4%) patients after 10 years postgastrectomy. Regular follow-up was associated with a significantly decreased overall mortality rate after 5 years postgastrectomy (from 49.4% to 36.9% in 15-year mortality rate; P < .001), as well as significant improvement of postrecurrence survival rate after occurrence of late recurrence or GRC (from 32.7% to 71.1% in 5-year postrecurrence survival rate; P < .001). Comparison of follow-up methods revealed that the combination of endoscopy and abdominopelvic computed tomography (CT) (only abdominopelvic CT in total gastrectomy subgroup) yielded the highest 5-year postrecurrence survival rate (endoscopy alone vs abdominopelvic CT alone vs a combination of both, 54.5% vs 47.1% vs 74.5%, respectively). A time interval of more than 2 years between previous endoscopy or abdominopelvic CT and late recurrence and GRC diagnosis was associated with a significantly reduced postrecurrence survival rate (hazard ratio, 1.72 [95% CI, 1.45-2.04] and 1.48 [95% CI, 1.25-1.75], respectively).Conclusions and RelevanceThese findings suggest that extended regular follow-up after 5 years postgastrectomy should be implemented clinically and that current practice and value of follow-up protocols in postoperative care of patients with gastric cancer be reconsidered.

中文翻译：

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胃癌患者术后延长随访的可行性


重要性关于胃癌胃切除术后随访的传统研究和指南通常将重点限制在术后前 5 年。目的评估胃癌患者胃切除术后 5 年的长期定期随访与总体生存率和复发后生存率的关系。设计、设置和参与者这项基于人群的回顾性队列研究使用了2005年1月1日至2014年12月31日期间提取的韩国国民健康保险索赔数据，并检查了截至2021年12月31日的随访数据。没有复发或其他症状的患者胃切除术后 5 年的癌症患者被分为两组：进行定期随访的组和未进行定期随访的组。数据分析于2023年8月15日至11月15日之间。暴露胃切除术后5年定期随访与不定期随访。主要结果和措施主要结果是胃切除术后5年延长定期随访是否与总体和不定期随访独立相关。使用 Cox 比例风险回归计算复发后生存率。比较不同随访方法和时间间隔的复发后生存率。结果共纳入40 468例胃癌患者，其中常规随访组14 294例（平均[SD]年龄，61.3 [11.7]岁； 9669 名男性 [67.8%]）和 26174 名不定期随访组（平均 [SD] 年龄，58.1[11.1] 岁；18007 名男性 [68.8%]）。 3138 名患者 (7.8%) 发现晚期复发或残胃癌 (GRC)，其中胃切除术后 5 至 10 年的 40 468 名患者中的 1610 名 (4.0%) 以及胃切除术后 10 年后的 16 287 名患者中的 1528 名 (9.4%)。 定期随访与胃切除术后 5 年后总体死亡率显着降低（15 年死亡率从 49.4% 降至 36.9%；P < .001）以及发生胃切除术后复发后生存率显着改善相关。晚期复发或 GRC（复发后 5 年生存率从 32.7% 降至 71.1%；P < .001）。随访方法的比较显示，内窥镜检查与腹盆腔计算机断层扫描（CT）（仅在全胃切除亚组中仅腹盆腔CT）相结合产生了最高的5年复发后生存率（单独内窥镜检查与单独腹盆腔CT与两者组合，分别为 54.5% 和 47.1% 和 74.5%）。先前内窥镜检查或腹盆腔 CT 与晚期复发和 GRC 诊断之间的时间间隔超过 2 年，与复发后生存率显着降低相关（风险比，1.72 [95% CI，1.45-2.04] 和 1.48 [95% CI， 1.25-1.75]，分别）。结论和相关性这些研究结果表明，临床上应实施胃切除术后5年的长期定期随访，并重新考虑目前胃癌患者术后护理中随访方案的实践和价值。