This study identifies key predictors of recurrence in esophagogastric junction adenocarcinoma (AEG) after treatment, emphasizing the significant role of distant recurrence in patient outcomes.

• Of 455 patients, 36.9% experienced distant recurrence, with a 12-month post-recurrence survival rate of 62% for single-site versus 42% for multiple-site recurrences.
• Independent predictors of local recurrence included neoadjuvant chemoradiotherapy and mucinous histology; advanced stage, poor therapy response, and perineural invasion were linked to distant recurrence.

Surgeons should consider these factors to identify high-risk patients who may benefit from intensified systemic therapy and tailored surveillance strategies post-treatment.