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Comparative Study
. 2025 Apr 18;25(1):731.
doi: 10.1186/s12885-025-14103-1.

Efficacy and safety of XELOX combined with neoadjuvant radiotherapy versus neoadjuvant chemotherapy in locally advanced gastric cancer

Shanshan Bu #  1 , Siyi Wang #  2 , Ting Wang #  1 , Hang Xing  3 , Yue Cao  4 , Zhandong Zhang  5 , Chuang Shang  5 , Xiance Tang  6 , Yifei Liu  7 , Xiaoqun Dong  8 , Xiushen Wang  9
Affiliations
Comparative Study

Efficacy and safety of XELOX combined with neoadjuvant radiotherapy versus neoadjuvant chemotherapy in locally advanced gastric cancer

Shanshan Bu et al. BMC Cancer. .

Abstract

Background: The work aimed to compare the efficacy and safety of chemotherapy regimen (oxaliplatin + capecitabine, XELOX) combined with neoadjuvant radiotherapy (NART) and neoadjuvant chemotherapy (NACT) in locally advanced gastric cancer.

Methods: We retrospectively analyzed clinical data from patients with locally advanced gastric cancer who underwent radical gastrectomy with D2 lymph node dissection at our center between January 2019 and December 2020. The study compared tumor markers, postoperative pathology, short-term efficacy, postoperative complications, and hospital stay between the chemoradiotherapy (CRT, XELOX + NART) group and the NACT-only group. Pearson correlation coefficients was used to analyze the correlations between clinical variables and tumor biomarkers. Inverse probability weighting (IPW) was used to adjust for confounding factors.

Results: A total of 409 patients were included, with 369 (90.2%) in the NACT group and 40 (9.8%) in the CRT group. Significant correlations were found between clinical variables and tumor biomarkers, which may help identify potential prognostic factors for gastric cancer treatment. After IPW adjustment, baseline characteristics were similar between groups. The negative conversion rate of CEA-positive patients was significantly higher in the CRT group (38.1% vs. 11.8%, P < 0.001). The rate of pathological complete response was also higher in the CRT group (15.8% vs. 4.7%, P = 0.017). Postoperative pathological stages ypT0 and T1 were observed in 35.5% of the CRT group compared to 13.5% in the NACT group (P = 0.031). The CRT group had a lower average number of lymph nodes dissected (17 vs. 24, P < 0.001) but a higher ypN0 rate (60.3% vs. 39.8%, P = 0.024). The proportion of patients with tumor regression grade (TRG) 0-1 was higher in the CRT group (60.3% vs. 24.3%, P = 0.003). The R0 resection rate after IPW was 100% in the CRT group versus 96.5% in the NACT group (P = 0.001). No significant differences were found between the CRT and NACT groups in nerve invasion, vascular embolus, peritoneal invasion, bone marrow suppression, nausea, vomiting, esophagitis, diarrhea, other adverse reactions, postoperative complications, or average hospitalization time. The CRT group showed superior disease-free survival while no overall survival advantage (P < 0.05).

Conclusions: The XELOX regimen combined with neoadjuvant chemoradiotherapy provided superior downstaging, short-term pathological response, and local control benifits compared to perioperative chemotherapy alone, with similar surgical safety profiles.

Keywords: Locally advanced gastric cancer; Neoadjuvant chemoradiotherapy; Perioperative chemotherapy; Short-term efficacy.

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Conflict of interest statement

Declarations. Ethical recognition and consent to participate: This study was approved by the Ethics Committee of Henan Cancer Hospital (approval number: 2024 − 102), Patients were consented by an informed consent process that was reviewed by the Ethics Committee of Henan Cancer Hospital and certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Clinical trial number: not applicable.

Figures

Fig. 1
Fig. 1
The flowchart of patient selection
Fig. 2
Fig. 2
Standardized mean difference: (SMD) diagram of equalization between propensity score matching (PSM) and inverse probability weighting (IPTW) groups
Fig. 3
Fig. 3
Correlation heatmap with p-values for clinical, biomarker and pathological features variables pre and post-treatment. A, The correlation heatmap shows the Pearson correlation coefficients between gender, age, tumor size (T), lymph nodal involvement (N), site of tumor, and biomarker variables before treatment (CEA, CA199, CA724). B, The correlation heatmap displays the Pearson correlation coefficients between treatment, CEA, CA199, CA724, changes in their biomarkers (∆CEA, ∆CA199, ∆CA724), tumor depth, tumor regression grade (TRG), nodal involvement (NI), lymphovascular space invasion (LVSI), and margin status post- treatment
Fig. 4
Fig. 4
Overall survival (A) and disease-free survival (B) in two group after IPTW method
Fig. 5
Fig. 5
Recurrence patterns in gastric cancer patients receiving adjuvant therapy after surgery. The figure illustrates the differences in recurrence proportions at various metastatic sites between the NACT and CRT
See this image and copyright information in PMC

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