A retro-prospective study to determine the patterns of recurrence in gastric and GE junction cancers after curative intent treatment at a tertiary cancer centre of North India.

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Background: Gastric cancer remains one of the leading causes of cancer-related mortality worldwide. Despite advancements in treatment modalities, recurrence continues to pose a significant challenge, severely impacting patient outcomes. This study aimed to analyze recurrence patterns and their associated factors in patients who underwent curative treatment for gastric cancer. Methods: We conducted a retrospective analysis of 446 patients who underwent curative-intent treatment, including surgery, neoadjuvant chemotherapy, and adjuvant therapy. Data on recurrence rates, tumor characteristics, treatment modalities, and surgical techniques were collected and analyzed. Statistical comparisons were performed to evaluate the influence of demographic factors, histological type, tumor location, pathological staging, and treatment approaches on recurrence outcomes. Results: The overall recurrence rate was 28.3%, with the majority occurring within 14 months (median 10 months) post-treatment. Recurrence rates were consistent across age groups, while males exhibited a slightly higher rate (29.8%) than females (23.7%). Tumors in the Pylorus and Antrum had the highest recurrence rates (32.0%), while the fundus showed a remarkably high rate (71.4%) in a small sample size. Poorly differentiated tumors and Signet Ring Cell carcinomas were associated with the highest recurrence rates (60.9%). Treatment approaches significantly influenced outcomes; patients receiving neoadjuvant chemotherapy, surgery, and adjuvant therapy had the lowest recurrence rate (24.1%). D2 lymphadenectomy and total gastrectomy were associated with better outcomes compared to D1 lymphadenectomy and proximal or distal gastrectomy. Advanced pathological staging (T4, N3) and higher tumor regression grades (TRG 4) correlated with higher recurrence rates. Peritoneal recurrence was the most common pattern (44.4%), followed by distant metastases (27.0%) and local recurrence (17.5%). Conclusions: This study highlights the multifactorial nature of gastric cancer recurrence, driven by tumor characteristics, treatment modalities, and surgical techniques. Peritoneal recurrence remains predominant, with most recurrences occurring within the first year post-treatment. These findings emphasize the importance of tailored treatment strategies, meticulous surgical approaches, and close monitoring during the initial months after treatment. Future research should focus on the biological mechanisms of recurrence and the development of targeted therapies to improve long-term survival in gastric cancer patients.