Clinicopathologic features and prognostic impact of late recurrence after gastrectomy for gastric cancer.

BACKGROUND: Most recurrences of gastric cancer (GC) occur within 2 years after curative gastrectomy, whereas late recurrence (≥ 3 years) has been less well studied. We aimed to clarify the clinicopathologic characteristics, recurrence patterns, and outcomes of late recurrence. METHODS: We retrospectively analyzed 8094 patients who underwent gastrectomy for GC at a single high-volume center between 2005 and 2024. Among 691 patients with recurrence, clinicopathologic features, recurrence patterns, and post-recurrence survival (PRS) were compared between early (< 3 years) and late (≥ 3 years) groups. RESULTS: Of 691 patients with recurrence, 104 (15.0%) developed late recurrence. Compared with early recurrence, the late recurrence group had a lower proportion of patients aged ≥ 75 years (9.6% vs. 18.6%). Late recurrence was more often observed in patients with carcinoembryonic antigen (CEA) ≤ 5 ng/mL (90.4% vs. 77.7%), carbohydrate antigen 19–9 (CA19-9) ≤ 37 U/mL (89.4% vs. 80.1%), pT1–2 stage (26.0% vs. 15.8%), and pN0 status (26.0% vs. 13.6%). Recurrence patterns differed by timing: 94.7% of hepatic recurrences developed within 3 years, while peritoneal, nodal, and bone recurrences remained relatively common beyond 3 years. Multivariate analysis of clinicopathologic factors associated with late recurrence identified CEA ≤ 5 ng/mL, pT1–2, pN0, and lymphatic invasion as significant characteristics. PRS did not differ significantly between the groups (5-year PRS: 10.4% vs. 9.4%, p = 0.096). CONCLUSIONS: Late recurrence accounted for 15% of all recurrences after curative gastrectomy. It was characterized by relatively early-stage disease features and distinct recurrence patterns, but survival after recurrence was comparable to that of early recurrence.