BACKGROUND:
Predictors of recurrence in patients with lymph node-negative gastric cancer (GC) who have undergone curative resection have been widely investigated, but not the effects of predictors on timing of recurrence.
OBJECTIVE:
Determine the factors associated with early and late recurrence in patients with node-negative GC.
DESIGN:
Retrospective cohort.
SETTING:
Academic tertiary care center.
PATIENTS AND METHODS:
The study included patients with node-negative GC after curative resection between 2008 and 2018 at two institutions. Early and late recurrences were determined using a minimum
P
value approach to evaluate the optimal cutoff for recurrence-free survival (RFS). A competing risk model and landmark analysis were used to analyze factors associated with early and late recurrences.
MAIN OUTCOME MEASURES:
Recurrence-free survival and factors associated with survival.
SAMPLE SIZE:
606.
RESULTS:
After a median follow-up of 70 months, 50 (8.3%) patients experienced recurrent disease. The optimal length of RFS for distinguishing between early (n=26) and late recurrence (n=24) was 24 months (
P
=.0013). The median RFS in the early and late recurrence groups was 11 and 32 months, respectively. Diffuse tumors (hazard ratio 3.358,
P
=.014), advanced T stage (HR 8.804,
P
=.003), perineural invasion (HR 10.955,
P
<.001), and anemia (HR 2.351,
P
=.018) were independent predictors of early recurrence. Mixed tumor location (HR 5.586,
P
=.002), advanced T stage (HR 5.066,
P
<.001), lymphovascular invasion (HR 5.902,
P
<.001), and elevated CA19-9 levels (HR 5.227,
P
<.001) were independent predictors of late recurrence. Similar results were obtained in the landmark analysis.
CONCLUSIONS:
Individualized therapeutic and follow-up strategies should be considered in future studies because of distinct patterns in predictors of early and late recurrence.
LIMITATIONS:
Retrospective design, small sample size.
CONFLICT OF INTEREST:
None.
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