Comparison of survival outcomes between de novo and recurrent stage IV gastric cancers: A retrospective cohort study

Purpose: This study analyzes the characteristics and prognosis of patients with de novo and recurrent metastatic gastric cancers.Methods: This retrospective study included 301 advanced, pathologically confirmed gastric cancer patients who received palliative chemotherapy between 2012 and 2022. The de novo cohort included patients who presented with distant metastasis at diagnosis, and the recurrent metastatic cohort was composed of patients with metastasis after curative gastrectomy. We analyzed prognostic association by Cox regression and compared survival time of both cohorts using the Kaplan-Meier survival analysis.Results: The study included 167 de novo and 112 recurrent patients. No differences were noted among the patients with de novo disease and recurrent metastatic disease concerning age, sex, Eastern Cooperative Oncology Group scores, primary cancer location, and pathologic features. Patients in the recurrent group versus the de novo group had a longer duration of chemotherapy (1.16±1.18 years vs. 0.85±0.84 years, P= 0.01) and lower mean body mass index (20.22±2.78 kg/m2 vs. 21.93±3.38 kg/m2, P< 0.001). The median overall survival in the de novo group was 11.6 versus 14.4 months in the recurrent group (P= 0.02).Conclusion: De novo and recurrent metastatic gastric cancer are characterized by distinct subpopulations. Advanced gastric cancer patients with recurrence have significantly better survival versus those in the de novo cohort. The differences between de novo and recurrent gastric cancer patient outcomes could facilitate discussions about the selection of the clinical trial of each patient and help with their personalized treatment.