Individualized postoperative follow-up strategy based on the molecular biomarker profiles of gastric cancer

Postoperative recurrence following radical gastrectomy is a critical determinant of long‑term survival in gastric cancer patients. The core objectives of postoperative surveillance include early detection of asymptomatic recurrence to improve prognosis, as well as monitoring of nutritional status and long‑term complications to preserve overall health. Although current guide-lines from Chinese Society of Clinical Oncology, Japan Gastric Cancer Association, National Compre-hensive Cancer Network of the United States, and other organizations have proposed pathological stage‑based follow‑up protocols, they differ in surveillance intensity and modality, and are largely lacking in high‑level medicine evidence‑based support. Individualized surveillance strategies based on molecular biomarkers are emerging as a new direction; molecular subtypes including microsate-llite instability‑high, Claudin 18.2, programmed death‑ligand 1, Epstein‑Barr virus, human epidermal growth factor receptor 2, fibroblast growth factor receptor 2 isoform b, and alpha‑fetoprotein have demonstrated certain associations with prognosis, recurrence patterns, and treatment‑related toxicities in gastric cancer, and may serve as supplementary references for individualized surveillance adjust-ments beyond standard staging. However, the existing evidence is predominantly derived from treatment/prognostic studies in advanced‑stage populations, and high‑level prospective validation specifically targeting postoperative surveillance strategies per se remains lacking. Dynamic monitoring of new biomarkers such as the circulating tumor DNA has shown potential advantages in the early warning of minimal residual disease; nevertheless, owing to the heterogeneity of gastric cancer, its diagnostic performance as a complementary monitoring tool and the issue of false positives remain to be clarified. For elderly patients of gastric cancer, a stratified surveillance plan should be developed with due consideration of life expectancy and quality of life. The authors systematically address the optimized pathways for postoperative surveillance strategies following radical gastrectomy for gastric cancer and their significance in improving patient prognosis.