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Predictors and Nomogram for Early Recurrence After Curative Gastrectomy for Gastric Cancer: A Non-East Asian Cohort
Yuri Goldes1, Tamir Lotan2, Jossy Braun1
1Division of Upper GI Surgery, Department of General Surgery, Sheba Medical Center, Ramat Gan, Israel.
Background:
Early recurrence after curative-intent gastrectomy for gastric cancer carries a poor prognosis. Existing predictive models derive almost exclusively from East Asian populations. This study aimed to identify risk factors for early recurrence, develop a nomogram, and characterize predictors of distinct recurrence patterns in a non-East Asian cohort.
Methods:
A retrospective single-center cohort study (2012-2023) included patients undergoing curative-intent gastrectomy for gastric adenocarcinoma. Early recurrence was defined as recurrence within 12 months. Preoperative and postoperative multivariable logistic regression models were constructed. Among patients who recurred, separate models examined peritoneal, liver, and locoregional recurrence patterns. Internal validation used bootstrap resampling.
Results:
Of 367 patients, 67 (18.3%) experienced early recurrence. The postoperative model (pT ≥ 3, pN ≥ 1, perineural invasion, R1 margin, CEA >5ng/mL) achieved AUC 0.826, with excellent calibration. A nomogram was constructed. Recurrence patterns differed significantly between early and late recurrence (P < 0.001): early recurrence was dominated by peritoneal and distant non-peritoneal spread, while late recurrence showed more locoregional involvement. Peritoneal recurrence was associated with perineural invasion (P = 0.006); liver recurrence was associated with elevated CEA (P = 0.017).
Conclusions:
Five clinicopathological variables predicted early recurrence in a non-East Asian cohort. Distant recurrence comprised two pathways with opposite CEA associations, suggesting surveillance strategies tailored to anatomical risk.
