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Updated: May 24, 2026
Establishment and Evaluation of a Risk Prediction Model for Pathological Escalation of Gastric Low-Grade Intraepithelial Neoplasia
Published on: February 16, 2024
Distinct postoperative recurrence patterns and independent risk factors: guiding individualized surveillance for
Yuhang Han1, Bowei Zhang1, Li Lv1
1Department of Gastrointestinal Surgery Section 2, Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Background:
High heterogeneity in postoperative recurrence patterns of early-onset gastric cancer (EOGC) has been reported, but few studies have comprehensively compared the recurrence risk factors and patterns between EOGC and late-onset gastric cancer (LOGC) after radical resection. This study aimed to evaluate the postoperative recurrence patterns and independent risk factors in both cohorts.
Methods:
Patients were classified as having EOGC or LOGC based on their age at diagnosis, with EOGC defined as age <50 years and LOGC as age ≥50 years. A retrospective analysis of 1868 patients (369 EOGC and 1499 LOGC) who underwent radical gastrectomy at The Sixth Affiliated Hospital of Sun Yat-sen University (July 2016 to June 2024) was performed. Univariate and multivariate Cox regression analyses identified recurrence risk factors, and restricted cubic spline curves were used to explore age-related nonlinear trends.
Results:
Peritoneal recurrence (59.2%) and multiple recurrence (21.4%) were predominant in EOGC, whereas LOGC demonstrated lower rates of peritoneal recurrence (35.9%) and multiple recurrence (25.2%). EOGC's unique independent risk factors included tumor size >3 cm, lymphovascular invasion, and elevated preoperative carbohydrate antigen (CA)19-9. LOGC's unique predictors were positive tumor deposits, diffuse type, perineural invasion, human epidermal growth factor receptor 2 positivity, high lymph node ratio, and elevated preoperative CA125. Restricted cubic spline identified optimal age cutoffs (EOGC, 42 years; LOGC, 63 years). Subgroup analysis showed a higher recurrence risk in patients with EOGC aged <42 years with positive perineural invasion and in patients with LOGC aged 50 to 62 years with multicentric tumors.
Conclusion:
EOGC and LOGC have distinct recurrence patterns and independent risk factors. These findings suggest that postoperative surveillance strategies may be better tailored according to individualized recurrence risk rather than being uniformly intensified across all patients.
