When and where: A study on gastric cancer recurrence after neoadjuvant/perioperative chemotherapy

doi:10.3748/wjg.117778

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Publication Name

World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Randomized Controlled Trial

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Aug 14, 2026; 32(30): 117778
Published online Aug 14, 2026. doi: 10.3748/wjg.117778

When and where: A study on gastric cancer recurrence after neoadjuvant/perioperative chemotherapy

Manlio Monti, Bianca Ceredi, Flavia Foca, Paolo Morgagni, Massimo Framarini, Bernadette Vertogen, Daniele Marrelli, Franco Roviello, Uberto Fumagalli Romario, Silvia Bozzarelli, Annibale Donini, Luigina Graziosi, Federica Filippini, Maria Bencivenga, Carlo Milandri, Gianni Mura, Gian Luca Baiocchi, Stefano Rausei, Chiara Molinari, Alessandro Passardi

Manlio Monti, Bianca Ceredi, Alessandro Passardi, Department of Medical Oncology, IRCCS Istituto Scientifico Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola 47014, Emilia-Romagna, Italy

Flavia Foca, Bernadette Vertogen, Unit of Biostatistics and Clinical Trials, IRCCS Istituto Scientifico Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola 47014, Emilia-Romagna, Italy

Paolo Morgagni, Massimo Framarini, Department of General Surgery, “Morgagni-Pierantoni” Hospital, Forlì 47121, Emilia-Romagna, Italy

Daniele Marrelli, Unit of Surgical Oncology, University of Siena, Siena 53100, Provincia di Siena, Italy

Franco Roviello, Department of Surgical Oncology, University of Siena, Siena 53100, Provincia di Siena, Italy

Uberto Fumagalli Romario, Department of Digestive Surgery, European Institute of Oncology, IRCCS, Milano 20141, Lombardia, Italy

Silvia Bozzarelli, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano 20089, Lombardia, Italy

Annibale Donini, Luigina Graziosi, Department of General and Emergency Surgery, University of Perugia, Perugia 06129, Umbria, Italy

Federica Filippini, Maria Bencivenga, General and Upper GI Surgery Division, University of Verona, Verona 37129, Veneto, Italy

Carlo Milandri, Department of Oncology, “San Donato” Hospital, Arezzo 52100, Tuscany, Italy

Gianni Mura, Department of General Surgery, “San Donato” Hospital, Arezzo 52100, Tuscany, Italy

Gian Luca Baiocchi, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Lombardia, Italy

Stefano Rausei, General Surgery Unit, Cittiglio/Angera Hospital, ASST Sette Laghi, Cittiglio 21033, Varese, Italy

Chiara Molinari, Biosciences Laboratory, IRCCS Istituto Scientifico Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola 47014, Emilia-Romagna, Italy

Author contributions: Monti M designed the research study; Monti M, Morgagni P, Framarini M, Marrelli D, Roviello F, Fumagalli Romario U, Bozzarelli S, Donini A, Graziosi L, Filippini F, Bencivenga M, Milandri C, Mura G, Baiocchi GL, Rausei S acquired the data; Monti M and Morgagni P interpreted the data; Vertogen B managed the data; Foca F performed the statistical analysis; Monti M, Ceredi B, Foca F, Molinari C drafted the manuscript; Bozzarelli S, Passardi A, Morgagni P, Baiocchi GL and Rausei S critically revised the manuscript for important intellectual content; all authors have read and agreed to the published version of the manuscript.

Institutional review board statement: The study was approved by the IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori” Institutional review board (No. 471 of 21/07/2010) and by the Local Ethics Committees.

Clinical trial registration statement: The trial was registered on ClinicalTrial.gov website (No. NCT01876927) and in the EudraCT database (No. 2010-020189-37).

Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.

Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at flavia.foca@irst.emr.it. Participants gave informed consent for data sharing.

Corresponding author: Flavia Foca, BStat, Researcher, Unit of Biostatistics and Clinical Trials, IRCCS Istituto Scientifico Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Via P. Maroncelli 40, Meldola 47014, Emilia-Romagna, Italy. flavia.foca@irst.emr.it

Received: December 24, 2025
Revised: February 12, 2026
Accepted: April 21, 2026
Published online: August 14, 2026
Processing time: 211 Days and 18.4 Hours

Core Tip

Core Tip: This randomized study provides long-term data on recurrence patterns after neoadjuvant or perioperative chemotherapy for resectable gastric cancer. Most relapses occurred at distant sites, with the highest risk within the first two years after surgery. These findings support risk stratification particularly given by interaction between tumor regression score and lymph nodes involvement. Time-dependent modelling suggested that the intestinal subtype is associated with a decreasing recurrence risk over time; however, this finding requires further validation.