{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T02:55:13Z","timestamp":1791428113864,"version":"4.3.3"},"reference-count":53,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"\n Importance<\/jats:title>\n Patients with gastric cancer face substantial risk of recurrence after surgical resection. Molecular profiling of primary tumors may improve risk stratification to guide postoperative management.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To identify genomic features of primary gastric tumors associated with disease recurrence and patterns of metastatic spread.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This single-center cohort study took place at an academic quaternary referral center and included patients who underwent curative-intent resection of gastric adenocarcinoma from 2010 to 2024. Patients were classified by recurrence status and pattern of metastatic spread. Patients with gastric cancer (stages I to III) who underwent a margin-negative resection and had genomic sequencing of their primary tumor were included. Primary analysis excluded patients who had no evidence of disease with less than 2 years of follow-up. These data were analyzed from June 2025 through March 2026.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Primary tumor specimens were sequenced using a targeted panel of cancer-associated genes (MSK-IMPACT).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Correlation of disease-free survival and patterns of metastatic spread (hematogenous, peritoneal, or lymphatic) with primary tumor genomic profile.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 438 patients who underwent complete oncologic resection, 377 had sufficient clinical follow-up or developed recurrence (median [IQR] age, 64 [55-71] years; 113 female [30%] and 264 male [70%]). Recurrence was identified in 179 patients, whereas 198 patients had no evidence of disease. In a multivariable analysis, alterations in\n KRAS<\/jats:italic>\n (hazard ratio [HR], 1.54; 95% CI, 1.04-2.28;\n P<\/jats:italic>\n \u2009=\u2009.03) and\n PIK3CA<\/jats:italic>\n (HR, 2.15; 95% CI, 1.25-3.69;\n P<\/jats:italic>\n \u2009=\u2009.006) were independently associated with worse disease-free survival. Tumors of patients with hematogenous recurrence had greater chromosomal instability (fraction genome altered, 0.11 vs 0.03;\n P<\/jats:italic>\n \u2009=\u2009.001), whole-genome duplication (47% vs 15%;\n P<\/jats:italic>\n \u2009=\u2009.02), and more frequent alterations of genes modulating cell cycle regulation (39% vs 6%;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) compared with peritoneal recurrence. Bone metastasis arose from more genomically stable primary tumors (fraction genome altered, 0.005 vs 0.114;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) and tumors with Lauren diffuse-type histology (36% vs 3%;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) compared with other sites of hematogenous spread.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This study identifies genomic alterations associated with disease-free survival and patterns of recurrence after resection of gastric cancer. These clinicogenomic risk factors may personalize postoperative surveillance strategies and inform perioperative treatment decisions.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamasurg.2026.3270","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T15:01:01Z","timestamp":1785942061000},"page":"1013","source":"Crossref","is-referenced-by-count":1,"title":["Primary Tumor Genomics and Patterns of Distant Recurrence in Resected Gastric Cancer"],"prefix":"10.1001","volume":"161","author":[{"given":"Max R.","family":"Coffey","sequence":"first","affiliation":[{"name":"Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jierui","family":"Xu","sequence":"additional","affiliation":[{"name":"Computational Oncology Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New 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