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. 2025 Jun 4:15:1539534.
doi: 10.3389/fonc.2025.1539534. eCollection 2025.

Updated long-term survival outcomes for patients with locally advanced gastric cancer having pathological complete response after neoadjuvant therapy at China National Cancer Center, 2004-2023

Chongyuan Sun #  1 , Tongbo Wang #  1 , Xiaojie Zhang #  1 , Lulu Zhao  1 , Penghui Niu  1 , Wanqing Wang  1 , Xiaoyi Luan  1 , Xue Han  1 , Yingtai Chen  1 , Dongbing Zhao  1
Affiliations

Updated long-term survival outcomes for patients with locally advanced gastric cancer having pathological complete response after neoadjuvant therapy at China National Cancer Center, 2004-2023

Chongyuan Sun et al. Front Oncol. .

Abstract

Background: Neoadjuvant chemotherapy increases the probability of achieving negative margins and may even lead to pathological complete response (pCR) in locally advanced gastric cancer (LAGC). The incorporation of neoadjuvant immunotherapy is promising in further enhancing the pCR rate. However, long-term survival outcomes and factors affecting the prognosis of pCR patients have not been fully elucidated.

Patients and methods: We conducted a retrospective analysis of all patients who achieved pCR between January 2004 and June 2023. Cox regression models were used to identify clinicopathological predictors of overall survival (OS) and disease-free survival (DFS). Survival curves were plotted using the Kaplan-Meier method and compared using the log-rank test.

Results: After screening, 112 patients were included in the study, with a median follow-up time of 42 (range: 2-117) months and a pCR rate of 7.4%. The 3- and 5-year OS rates were 90.2% and 83.3%, respectively, while the 3- and 5-year DFS rates were 86.8% and 82.0%, respectively. Within the multivariate Cox model, neoadjuvant chemotherapy was a prognostic factor for improved OS and DFS. There was no statistically significant disparity in OS and DFS between patients who received postoperative adjuvant therapy and those who did not. Moreover, the combination of neoadjuvant immunotherapy with chemotherapy, as compared to neoadjuvant chemotherapy alone, substantially increased the pCR rate (p <0.001).

Conclusions: Patients with LAGC who achieved pCR demonstrated favorable long-term survival outcomes, with no additional survival benefits conferred by adjuvant therapy. Although neoadjuvant immunotherapy increased the pCR rate, its impact on the prognosis of pCR patients requires further investigation.

Keywords: gastric cancer; immunotherapy; neoadjuvant therapy; pathological complete response (pCR); prognostic factor.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Comparison of pCR rates between neoadjuvant chemotherapy alone and neoadjuvant chemotherapy combined with immunotherapy (pCR pathological complete regression, nCT alone neoadjuvant chemotherapy alone, nCTI neoadjuvant chemotherapy combined with immunotherapy).
Figure 2
Figure 2
OS (A) and DFS (B) survival curves for patients with pCR after neoadjuvant therapy and resection (OS, overall survival; DFS, disease-free survival; pCR, pathological complete response).
Figure 3
Figure 3
OS (A) and DFS (B) survival curves for patients with pCR who received nCT and those who received nCRT (OS, overall survival; DFS, disease-free survival; pCR, pathological complete response; nCT, neoadjuvant chemotherapy; nCRT, neoadjuvant chemoradiotherapy).
Figure 4
Figure 4
OS (A) and DFS (B) survival curves for patients with pCR who received adjuvant therapy and those who did not (OS, overall survival; DFS, disease-free survival; pCR, pathological complete response).
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