Recurrence risk prediction of small-molecule drugs plus chemo in postoperative gastric cancer: Retrospective analysis via molecular markers

doi:10.4240/wjgs.122160

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World Journal of Gastrointestinal Surgery

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1948-9366

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

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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 Gastrointest Surg. Oct 27, 2026; 18(10): 122160
Published online Oct 27, 2026. doi: 10.4240/wjgs.122160

Recurrence risk prediction of small-molecule drugs plus chemo in postoperative gastric cancer: Retrospective analysis via molecular markers

Yong Yang, Han-Dan Liu, Xing-Yong Yang, Xue Li, Li-Jun Cui

Yong Yang, Xing-Yong Yang, Xue Li, Li-Jun Cui, Department of Blood Transfusion, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China

Han-Dan Liu, Department of Ophthalmology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China

Co-first authors: Yong Yang and Han-Dan Liu.

Author contributions: Yang Y and Liu HD contributed equally to this work as co-first authors and they participated in research design, data collection, statistical analysis, and manuscript drafting; Cui LJ is the corresponding author and responsible for project supervision, critical revision of the manuscript, and final approval; Yang XY and Li X assisted in data collation, literature review and manuscript revision; and all the authors have read and approved the final manuscript.

AI contribution statement: The authors declare that no AI tools were used in the development or writing of this manuscript and take full responsibility for its integrity, accuracy, and originality.

Institutional review board statement: This study has been reviewed and approved by the Medical Ethics Committee of Affiliated Hospital of North Sichuan Medical College (Approval No. 2025ER715-1).

Informed consent statement: All the individuals who participated in this study provided their written informed consent prior to study enrolment.

Conflict-of-interest statement: The authors declare no conflicts of interest.

Data sharing statement: No additional data are available.

Corresponding author: Li-Jun Cui, Chief Physician, Department of Blood Transfusion, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Shunqing District, Nanchong 637000, Sichuan Province, China. liuhandan1013@163.com

Received: April 30, 2026
Revised: May 25, 2026
Accepted: June 12, 2026
Published online: October 27, 2026
Processing time: 166 Days and 13.3 Hours

Abstract

BACKGROUND

Gastric cancer (GC) exhibits high postoperative recurrence rates even after adjuvant small-molecule and chemotherapy therapy. Reliable molecular markers are urgently needed to accurately predict recurrence risk and guide precise clinical treatment.

AIM

To investigate the clinical value of molecular markers in predicting recurrence risk in patients with postoperative GC receiving small-molecule drugs combined with chemotherapy.

METHODS

The clinical data of 136 patients with postoperative GC who received adjuvant therapy with small-molecule drugs combined with chemotherapy at our hospital between September 2023 and January 2025 were retrospectively analyzed. Based on the follow-up outcomes, the patients were divided into a recurrence group (38 cases) and a non-recurrence group (98 cases). Baseline data and molecular marker test results were compared between the groups. Factors influencing recurrence after treatment and the predictive value of molecular markers for recurrence risk were analyzed.

RESULTS

There were no significant differences in baseline data, including sex, body mass index, primary tumor location, The Cancer Genome Atlas subtype, or serum levels of carcinoembryonic antigen, alpha-fetoprotein, and CA125, between the two groups (P > 0.05). The recurrence group showed significantly higher proportions of age ≥ 60 years, poorly differentiated tumors, TNM stage III-IV, programmed death-ligand 1 (PD-L1) positivity, and higher tumor mutation burden (TMB) expression than the non-recurrence group (P < 0.05). Binary Logistic regression analysis showed that age (≥ 60 years), poor differentiation, TNM stages III-IV, PD-L1 positivity, and high TMB expression were independent risk factors for recurrence (OR = 3.126, 1.852, 4.109, 6.174, and 1.627, respectively; all P < 0.05). The area under the curve of the combined detection of PD-L1 positivity and TMB for predicting recurrence was 0.983, which was higher than that of single-molecule marker detection (P < 0.05).

CONCLUSION

Detection of molecular markers such as PD-L1 and TMB is highly valuable for predicting recurrence risk in GC patients. A combined analysis of baseline characteristics can further clarify the risk of recurrence after adjuvant therapy with small-molecule drugs combined with chemotherapy.

Keywords: Smallmolecule drugs; Chemotherapy; Gastric cancer; Recurrence risk; Molecular markers

Core Tip: This study retrospectively analyzed 136 patients with postoperative gastric cancer receiving small-molecule drugs and chemotherapy. Programmed death-ligand 1 and tumor mutation burden are independent risk factors for recurrence, and their combined detection has a high predictive value.