{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T21:12:45Z","timestamp":1793308365143,"version":"4.5.0"},"reference-count":28,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Perioperative fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) is the standard of care for resectable gastric and gastroesophageal junction adenocarcinoma; however, up to 50% of patients develop metastatic recurrence. These patients have prior exposure to platinum and taxane agents, and optimal first-line treatment in the metastatic setting remains undefined. This study aimed to characterize real-world treatment patterns and outcomes in patients progressing after perioperative FLOT, focusing on relapse timing and HER2 status. Materials and Methods: This retrospective, multicenter cohort study included 296 patients from 31 centers across T\u00fcrkiye, stratified into early relapse (\u22646 months, n = 114) and late relapse (&gt;6 months, n = 182) groups. Survival analyses were performed using the Kaplan-Meier method and Cox proportional hazards regression. Primary endpoints were progression-free survival (PFS) and overall survival (OS). Results: Median PFS and OS for the entire cohort were 6 and 9 months, respectively. Early relapsers had significantly shorter median PFS (4 vs. 6 months, p = 0.029) and OS (8 vs. 12 months, p = 0.047); however, early relapse timing did not retain independent prognostic significance on multivariable analysis. No significant difference in PFS or OS was observed between cytotoxic chemotherapy regimens in either relapse group. HER2 positivity was the only independent predictor of improved PFS on multivariable Cox analysis (HR 0.48, 95% CI 0.29\u20130.81; p = 0.006). In the late relapse group, trastuzumab-based chemotherapy achieved a median PFS of 14 months and OS of 18 months, significantly superior to all cytotoxic regimens (PFS p = 0.007; OS p = 0.029). Conclusions: In patients progressing after perioperative FLOT, cytotoxic chemotherapy regimen selection did not demonstrate a statistically significant survival difference in this retrospective cohort, regardless of relapse timing. HER2 positivity is the dominant predictive biomarker, and trastuzumab-based therapy suggests a potential survival benefit that warrants prospective validation. Comprehensive biomarker profiling at metastatic diagnosis and prospective trials designed for this post-FLOT population are needed to establish evidence-based treatment standards.<\/jats:p>","DOI":"10.3390\/medicina62050984","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T10:19:52Z","timestamp":1779877192000},"page":"984","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["First-Line Treatment After Perioperative FLOT in Recurrent Gastric and Gastroesophageal Junction Cancer: A Turkish Oncology Group (TOG) Multicenter Real-World Analysis"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4841-7994","authenticated-orcid":false,"given":"Mustafa","family":"Seyyar","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Gaziantep City Hospital, \u0130bn-i Sina Neighborhood, 27470 Gaziantep, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pervin","family":"Can \u015eanc\u0131","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Kocaeli University, 41380 Kocaeli, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2538-8569","authenticated-orcid":false,"given":"Abdullah","family":"Sakin","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Bah\u00e7elievler Medipol University Hospital, 34196 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1782-7808","authenticated-orcid":false,"given":"Ayberk","family":"Bayramgil","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, SBU Umraniye Training and Research Hospital, 34676 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6zgecan","family":"D\u00fclgar Kaya","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, SBU Umraniye Training and Research Hospital, 34676 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erdem","family":"S\u00fcnger","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Istanbul Medipol University, 34810 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6zg\u00fcr","family":"A\u00e7\u0131kg\u00f6z","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Istanbul Medipol University, 34810 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9110-4280","authenticated-orcid":false,"given":"Teyfik","family":"Demir","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Ondokuz May\u0131s University,\u00a055200 Samsun, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Recep","family":"T\u00fcrkel","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Ondokuz May\u0131s University,\u00a055200 Samsun, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bahiddin","family":"Y\u0131lmaz","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Ondokuz May\u0131s University,\u00a055200 Samsun, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2863-3243","authenticated-orcid":false,"given":"Faruk Recep","family":"\u00d6zalp","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Dokuz Eylul University, 35340 Izmir, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7083-8517","authenticated-orcid":false,"given":"H\u00fcseyin Salih","family":"Semiz","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Dokuz Eylul University, 35340 Izmir, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6858-6974","authenticated-orcid":false,"given":"G\u00fcl Sema","family":"Y\u0131ld\u0131ran","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Gulhane Training and Research Hospital, 06010 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7538-9119","authenticated-orcid":false,"given":"Musa Bar\u0131\u015f","family":"Aykan","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Gulhane Training and Research Hospital, 06010 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0572-4927","authenticated-orcid":false,"given":"G\u00f6rkem","family":"Turhan","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Karadeniz Technical University, 61080 Trabzon, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6067-5646","authenticated-orcid":false,"given":"Atila","family":"Y\u0131ld\u0131r\u0131m","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Karadeniz Technical University, 61080 Trabzon, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serkan","family":"Menek\u015fe","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Manisa City Hospital, 45010 Manisa, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5328-5607","authenticated-orcid":false,"given":"Engin","family":"Kut","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Manisa City Hospital, 45010 Manisa, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5362-6109","authenticated-orcid":false,"given":"Mehmet","family":"\u00c7akmak","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Ankara Bilkent City Hospital, 06800 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8917-9267","authenticated-orcid":false,"given":"Efnan","family":"Alg\u0131n","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Ankara Bilkent City Hospital, 06800 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1976-3951","authenticated-orcid":false,"given":"Elif","family":"\u015eahin","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Kocaeli City Hospital, 41060 Kocaeli, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"An\u0131l","family":"Karakayal\u0131","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Kocaeli City Hospital, 41060 Kocaeli, 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T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2727-7387","authenticated-orcid":false,"given":"Ay\u015feg\u00fcl","family":"Mer\u00e7 \u00c7etinkaya","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Akdeniz University,\u00a007070 Antalya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7197-211X","authenticated-orcid":false,"given":"Sinem","family":"Akba\u015f","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Ko\u00e7 University Hospital, 34010 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1053-0668","authenticated-orcid":false,"given":"Sedat","family":"Biter","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Cukurova University Balcal\u0131 Hospital, 01330 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Izmir, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devrim","family":"\u00c7abuk","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Kocaeli University, 41380 Kocaeli, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaz\u0131m","family":"Uygun","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Kocaeli University, 41380 Kocaeli, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sema","family":"Sezgin G\u00f6ksu","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Akdeniz University,\u00a007070 Antalya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0598-7284","authenticated-orcid":false,"given":"\u00d6zg\u00fcr","family":"Tanr\u0131verdi","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Mu\u011fla S\u0131tk\u0131 Ko\u00e7man University,\u00a048000 Mu\u011fla, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatih","family":"Sel\u00e7ukbiricik","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Ko\u00e7 University Hospital, 34010 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8596-4233","authenticated-orcid":false,"given":"Mehmet","family":"Uzun","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, SBU Tepecik Training and Research Hospital, 35020 Izmir, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2360-3392","authenticated-orcid":false,"given":"\u0130lker Nihat","family":"\u00d6kten","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, G\u00f6ztepe City Hospital, Istanbul Medeniyet University, 34722 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burak","family":"Mete","sequence":"additional","affiliation":[{"name":"Department of Public Health, Faculty of Medicine, \u00c7ukurova University,\u00a001330 Adana, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tolga","family":"K\u00f6\u015feci","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Cukurova University Balcal\u0131 Hospital, 01330 Adana, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmet","family":"Bilici","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Istanbul Medipol University, 34810 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T\u00fclay","family":"Ku\u015f","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Gaziantep University,\u00a027310 Gaziantep, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6mer","family":"Dizdar","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Hacettepe University Cancer Institute, 06100 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u015euayib","family":"Yal\u00e7\u0131n","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Hacettepe University Cancer Institute, 06100 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6126-5377","authenticated-orcid":false,"given":"Umut","family":"Kefeli","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Kocaeli University, 41380 Kocaeli, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/s13045-023-01451-3","article-title":"Gastric cancer treatment: Recent progress and future perspectives","volume":"16","author":"Guan","year":"2023","journal-title":"J. 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