Lymph Node Ratio as a Risk Factor for Early Recurrence in Older Patients with Stage II/III Gastric Cancer: A Retrospective Study

<b>Background/Objectives:</b> Older adults with gastric cancer often have poorer prognoses than younger patients. Early recurrence, within two years after curative surgery, is associated with poor outcomes, but its risk factors remain unclear. This study aimed to identify clinicopathological predictors of early recurrence in older patients with stage II/III disease. <b>Methods:</b> We retrospectively reviewed 604 patients with stage II/III gastric cancer who underwent curative surgery from 2009 to 2020. After exclusions, 237 patients aged ≥65 years were analyzed. Clinicopathological variables were compared between those with and without early recurrence, and risk factors were assessed using logistic regression. <b>Results:</b> Among the 237 patients studied, 103 had recurrence following surgery, of whom 72 (69.9%) were categorized as early recurrence. Distant metastasis was the most common pattern (59.7%), followed by peritoneal (45.8%) and locoregional (33.3%) recurrences. Multivariate analysis identified a lymph node ratio (LNR) > 0.17 as an independent risk factor for early recurrence (odds ratio (OR), 5.30; 95% confidence interval (CI), 2.07-13.53; <i>p</i> < 0.001). <b>Conclusions:</b> Early recurrence is frequent among older patients with stage II/III gastric cancer, with distant metastasis as the predominant pattern. An LNR > 0.17 predicts higher recurrence risk. While adjuvant chemotherapy showed a trend toward reduced risk, statistical significance was not reached. Further prospective studies are necessary to confirm these findings.