European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2026
Temporal dynamics and spatial patterns of recurrence after curative gastrectomy for gastric cancer: A multicenter hazard function analysis of 3,278 patients.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Chen Sheng, Ding Ping'an, Guo Honghai, Gao Kaixuan, Gu Renjun, Zhang Lilong, Chen Yongli, Shi Yanlong, Long Hong, Meng Ning, Li Xiaolong, Guo Zhenjiang, Ma Wenqian, Meng Lingjiao, Zhao Qun
Аннотация
BACKGROUND: Postoperative recurrence remains the leading cause of treatment failure in gastric cancer despite curative resection. Current surveillance strategies do not adequately reflect time-varying recurrence risk. This study aimed to characterize the temporal dynamics and spatial patterns of recurrence using hazard function analysis to inform risk-adapted follow-up.
METHODS: In this multicenter retrospective cohort study, 3278 patients who underwent curative gastrectomy between 2012 and 2020 at ten tertiary centers in China were included. Kernel-smoothed hazard functions were applied to estimate instantaneous recurrence risk over time. Disease-free survival (DFS) and overall survival (OS) were analyzed using Kaplan-Meier and Cox regression models.
RESULTS: During a median follow-up of 61 months, 1630 patients (49.7%) developed recurrence. Overall recurrence risk peaked at 12.7 months postoperatively (hazard rate: 0.021). Stage-specific analysis showed an early and pronounced peak in stage III disease (13.9 months; hazard rate: 0.040), whereas stage II disease demonstrated a later, attenuated peak (17.0 months; hazard rate: 0.012). Peritoneal dissemination was the most aggressive pattern, peaking at 10.0 months and accounting for 29.1% of recurrences, while locoregional recurrence showed a delayed peak at 28.7 months (9.9%). Adjuvant chemotherapy status was associated with distinct recurrence hazard trajectories: patients without chemotherapy showed an earlier and higher peak at 10.3 months (hazard rate: 0.091), whereas those receiving chemotherapy showed a lower and later peak at 16.6 months (hazard rate: 0.037). Multivariable analysis identified pT4 stage, pN3 stage, lymphovascular invasion, and perineural invasion as independent risk factors, while adjuvant chemotherapy was protective.
CONCLUSIONS: Gastric cancer recurrence follows stage-dependent, non-linear trajectories with distinct temporal and site-specific patterns. The high-risk window of 10-20 months postoperatively may represent a relevant period for intensified surveillance, particularly for peritoneal dissemination. These findings provide a data-informed basis for generating risk-adapted, time-sensitive follow-up hypotheses that require prospective validation.
METHODS: In this multicenter retrospective cohort study, 3278 patients who underwent curative gastrectomy between 2012 and 2020 at ten tertiary centers in China were included. Kernel-smoothed hazard functions were applied to estimate instantaneous recurrence risk over time. Disease-free survival (DFS) and overall survival (OS) were analyzed using Kaplan-Meier and Cox regression models.
RESULTS: During a median follow-up of 61 months, 1630 patients (49.7%) developed recurrence. Overall recurrence risk peaked at 12.7 months postoperatively (hazard rate: 0.021). Stage-specific analysis showed an early and pronounced peak in stage III disease (13.9 months; hazard rate: 0.040), whereas stage II disease demonstrated a later, attenuated peak (17.0 months; hazard rate: 0.012). Peritoneal dissemination was the most aggressive pattern, peaking at 10.0 months and accounting for 29.1% of recurrences, while locoregional recurrence showed a delayed peak at 28.7 months (9.9%). Adjuvant chemotherapy status was associated with distinct recurrence hazard trajectories: patients without chemotherapy showed an earlier and higher peak at 10.3 months (hazard rate: 0.091), whereas those receiving chemotherapy showed a lower and later peak at 16.6 months (hazard rate: 0.037). Multivariable analysis identified pT4 stage, pN3 stage, lymphovascular invasion, and perineural invasion as independent risk factors, while adjuvant chemotherapy was protective.
CONCLUSIONS: Gastric cancer recurrence follows stage-dependent, non-linear trajectories with distinct temporal and site-specific patterns. The high-risk window of 10-20 months postoperatively may represent a relevant period for intensified surveillance, particularly for peritoneal dissemination. These findings provide a data-informed basis for generating risk-adapted, time-sensitive follow-up hypotheses that require prospective validation.