Prognostic factors associated with recurrence-free and overall survival in patients with gastric cancer: a single-center retrospective study

Objective. To evaluate the impact of clinicopathological, molecular, and treatment-related factors on recurrence-free 
survival (RFS) and overall survival (OS) in patients with localized and locally advanced gastric cancer following radical 
surgical treatment.
Materials and Methods. A retrospective single-center analysis was conducted including 422 patients with gastric cancer 
and gastroesophageal junction cancer who underwent radical surgical treatment between 2018 and 2021. Demographic 
characteristics, clinicopathological parameters, TNM staging variables, tumor differentiation grade, presence of perineural 
invasion (PNI) and lymphovascular invasion (LVI), lymph node ratio (LNR), inflammatory hematological markers (white 
blood cell, neutrophil, lymphocyte, and platelet counts, neutrophil-to-lymphocyte ratio [NLR], and platelet-to-lymphocyte 
ratio [PLR]), as well as molecular biomarkers including HER2, microsatellite instability (MSI), and PD-L1 were evaluated.
Statistical analyses were performed using the Kaplan–Meier method with comparisons by the log-rank test. All patients 
underwent staging and preoperative evaluation according to the national clinical guidelines of the Ministry of Health of 
the Russian Federation, including blood tests, esophagogastroduodenoscopy (EGD), tumor biopsy with histopathological 
and molecular assessment, and contrast-enhanced computed tomography of the whole body. Each case was discussed at a 
multidisciplinary tumor board to determine the optimal treatment strategy. All patients included in the analysis underwent 
planned R0 gastrectomy with D2 lymphadenectomy. Histological subtypes other than adenocarcinoma were excluded. 
Pathological staging was performed according to the 8th edition of the Union for International Cancer Control (UICC) 
TNM classification.
Results. The median follow-up duration was 52.2 months (range, 1–89.3 months). Disease recurrence was documented 
in 134 of 380 patients (35.3%) with available recurrence-free survival data. At the time of analysis, overall survival data were 
available for 409 patients, of whom 196 (47.9%) were alive and 213 (52.1%) had died.
The most significant adverse prognostic factors for both RFS and OS were advanced tumor stage (cT/pT and cN/pN 
categories), elevated LNR, the presence of perineural and lymphovascular invasion, and poor tumor differentiation (G3) 
(all p < 0.05). The most favorable oncological outcomes were observed in patients with MSI-H tumors, with recurrence and 
mortality rates of 33.3% compared with 50.7% and 61.3%, respectively, in patients with microsatellite-stable (MSS) tumors. 
HER2-positive status was associated with poorer survival outcomes, with disease recurrence observed in 75.0% of patients 
compared with 44.6% among those with HER2-negative tumors.
Conclusion. The prognosis of patients with localized and locally advanced gastric cancer after radical surgical treatment 
is determined by a combination of pathological stage, tumor morphology, and molecular characteristics. The most important 
prognostic factors include depth of tumor invasion, regional lymph node status, lymph node ratio, presence of perineural 
and lymphovascular invasion, and tumor MSI status.