• Jian-Wei Sun, Dao-Li Liu, Jia-Xian Chen, Li-Zhen Lin, Lv-Ping Zhuang, and Xian-Hai Hou.
• From the Department of Surgery, Qingyang's People's Hospital, Qingyan, China.
• Ann Saudi Med. 2021 Nov 1; 41 (6): 336-349.

BackgroundPredictors 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.ObjectiveDetermine the factors associated with early and late recurrence in patients with node-negative GC.DesignRetrospective cohort.SettingAcademic tertiary care center.Patients And MethodsThe 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 MeasuresRecurrence-free survival and factors associated with survival.Sample Size606.ResultsAfter 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.ConclusionsIndividualized therapeutic and follow-up strategies should be considered in future studies because of distinct patterns in predictors of early and late recurrence.LimitationsRetrospective design, small sample size.Conflict Of InterestNone.

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