Abstract
BACKGROUND: The postoperative recurrence of gastric cancer, especially early recurrence, significantly impacts the prognosis of patients. We aimed to identify factors affecting patient post-recurrence survival and identify patients who would experience early postoperative recurrence, facilitating prompt preoperative intervention. METHODS: Clinical and pathological data from 295 gastric cancer patients who underwent gastrectomy and D2 lymphadenectomy were retrospectively analyzed. The classification of tumor and nodal status was updated on the basis of the 8th edition of the American Joint Committee on Cancer's tumor-node-metastasis (TNM) system for gastric cancer. Survival data were acquired from medical records and follow-up phone calls. Recurrence was diagnosed based on radiological imaging, endoscopic biopsy, and intraoperative findings during reoperation. Categorical variables were analyzed for differences via Fisher's exact test or Pearson's χ² test. And for survival analysis, we applied Kaplan‒Meier method curves, which were compared with the log-rank test. Further univariate and multivariate Cox regression analyses were employed to identify variables associated with post-recurrence survival and early recurrence. Time-dependent receiver operating characteristic (ROC) analysis and time-dependent area under the curve (AUC) analysis was performed to evaluate and compare the predictive performance of these factors. RESULTS: A total of 295 patients were included in this study, with a mean age of 65.6 years. K‒M survival curves revealed that the overall survival rate (OS) and post-recurrence survival (PRS) rate in the late recurrence group were significantly higher than those in the early recurrence group (P < 0.05). Cox regression analyses identified early recurrence (HR = 2.136, 95%CI: 1.291-3.534) and a postoperative albumin (ALB) level < 35 g/L (HR = 2.107, 95%CI: 1.187-3.741) as independent risk factors and a body mass index (BMI) ≥ 25kg/m(2) (HR= 0.544, 95%CI: 0.297-0.997) as a protective factor for PRS. Further Cox regression analyses indicated that higher T stage (HR = 6.589, 95%CI: 1.513-28.696), higher N stage (HR = 2.305, 95%CI: 1.185-4.480) and serum carbohydrate antigen 19-9 (CA19-9) level > 37U/mL (HR = 1.889, 95%CI: 1.023-3.489) were independent risk factors for early recurrence. CONCLUSIONS: Patients with early recurrence had a poorer prognosis than those with late recurrence. Decreased postoperative albumin was the other independent risk factor for PRS, with high BMI being an independent protective factor for PRS. Higher T stage, higher N stage and elevated serum CA19-9 were independent risk factors for early recurrence.