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Meta-Analysis
. 2025 May 14;16(7):e00860.
doi: 10.14309/ctg.0000000000000860. eCollection 2025 Jul 1.

Predictive Value of Tumor Regression Grading on the Prognosis of Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer: A Systematic Review and Meta-Analysis

Ruchen Wu  1 , Shuying Lin  2 , Junze Chen  1 , Gang Wang  1   3 , Lulu Han  1   3
Affiliations
Meta-Analysis

Predictive Value of Tumor Regression Grading on the Prognosis of Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer: A Systematic Review and Meta-Analysis

Ruchen Wu et al. Clin Transl Gastroenterol. .

Abstract

Introduction: Tumor regression grade (TRG) after neoadjuvant chemotherapy is recognized as a significant and favorable prognostic indicator in various cancer types. However, this relationship remains less defined and has not been systematically investigated in locally advanced gastric cancer (LAGC). To address this gap, we conducted a meta-analysis aimed at assessing the prognostic influence of tumor regression after preoperative therapy on disease-free survival (DFS) and overall survival (OS) among patients with LAGC.

Methods: A systematic search was conducted across the following databases: PubMed, Web of Science, Embase, Cochrane, WF, CNKI, SinoMed, and VIP. The primary outcomes included DFS and OS, estimated using hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). Subsequently, either the fixed-effects model or the random-effects model was used to compute HR and 95% CI based on the results of heterogeneity analysis.

Results: A total of 11 studies, comprising 2,733 patients, were included in the final analysis. The results indicated that a lower TRG was associated with prolonged DFS (HR 0.53, 95% CI 0.32-0.88) and prolonged OS (HR 0.59, 95% CI 0.39-0.87) in patients with LAGC who received neoadjuvant chemotherapy. Sensitivity analysis demonstrated that no single study significantly influenced the results for both DFS and OS. Publication bias was identified in the meta-analysis for OS, whereas no publication bias was detected in the meta-analysis for DFS.

Discussion: A lower TRG score is associated with improved DFS and OS in patients with LAGC receiving neoadjuvant chemotherapy.

Keywords: local advanced gastric cancer; meta-analysis; neoadjuvant chemotherapy; overall survival; tumor regression grade.

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Conflict of interest statement

Guarantor of the article: Lulu Han.

Specific author contributions: All authors contributed to the study conception and design. R.W.: writing—original draft preparation. R.W., G.W., and J.C.: writing—review and editing. R.W.: conceptualization and methodology. R.W., S.L., and J.C.: formal analysis and investigation. R.W. and L.H.: funding acquisition, resources, and supervision. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Financial support: The study was supported by Jiangsu Training Program of Innovation and Entrepreneurship for Undergraduates (202310313050Z), National Natural Science Foundation of China (82203172, 82273334, 81871869, and 81400055), The Xuzhou Medical University Excellent Talent Research Start-up Fund (D2021058), The China Postdoctoral Science Foundation (2023M732970).

Potential competing interests: None to report.

Data availability: The data that support the findings of this study are available from the corresponding author upon reasonable request.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Flowchart of literature screening.
Figure 2.
Figure 2.
(a) Forest plots for the association between TRG and DFS. (b) Forest plots for the association between TRG and OS. CI, confidence interval; DFS, disease-free survival; HR, hazard ratio; OS, overall survival; TRG, tumor regression grade.
Figure 3.
Figure 3.
(a) Sensitivity analysis of DFS. (b) Sensitivity analysis of OS. CI, confidence interval; DFS, disease-free survival; OS, overall survival.
Figure 4.
Figure 4.
(a) Funnel plot for the publication bias for DFS. (b) Funnel plot for the publication bias for OS. DFS, disease-free survival; HR, hazard ratio; OS, overall survival.
Figure 5.
Figure 5.
Trim and fill for the publication bias for OS. OS, overall survival.
See this image and copyright information in PMC

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