Postoperative recurrence patterns and prognostic determinants in early-onset early-stage gastric cancer: A...

While most studies focus on postoperative recurrence in either early-onset (≤45 years) or early-stage gastric cancer, limited attention has been devoted to recurrence dynamics in early-onset EGC. This study characterized postoperative recurrence patterns and identifies clinicopathological risk factors in early-onset early-stage gastric cancer (EGC).

We analyzed 7131 patients undergoing curative gastrectomy for gastric cancer (January 2013-December 2019) at two high-volume centers in China, with focused evaluation of clinicopathological characteristics, recurrence patterns, and survival outcomes in early-onset EGC.

Among 252 early-onset EGC patients, 41 (16.3 %) developed recurrence, predominantly hematogenous (56.1 %) and peritoneal (34.1 %). Recurrence risk peaked at 10 months postoperatively, declined by 36 months, then gradually rebounded. The 5-year overall survival (OS) and recurrence-free survival (RFS) rates were 76.6 % and 70.2 %, respectively. Multivariate analysis identified elevated preoperative tumor markers, lymph node metastasis (N+), lymphovascular invasion (LVI+), and poor differentiation as independent predictors of recurrence. Early recurrence (≤2 years) was independently driven by elevated preoperative tumor markers and N+, while late recurrence (>2 years) linked to BMI≥25 kg/m² and LVI+. Subgroup analysis demonstrated that postoperative adjuvant chemotherapy significantly improved RFS (HR = 0.12) and OS (HR = 0.26) in pN2-3 patients compared with those without adjuvant chemotherapy.

Early-onset EGC patients with preoperative elevated tumor markers, N+, LVI+, or poor tumor differentiation demonstrated higher recurrence risk, warranting intensified surveillance within 2 years. Postoperative adjuvant chemotherapy is strongly recommended, particularly for pN2-3 disease. Extended follow-up is advised for patients with BMI≥25 kg/m² or LVI+.