Neoadjuvant Chemoradiotherapy in Locally Advanced Gastric Adenocarcinoma: Long-Term Results and Statistical Algorithm...

Area of Science:

• Oncology
• Gastroenterology
• Surgical Oncology

Background:

• Locally advanced gastric adenocarcinoma (LAGC) presents a significant clinical challenge.
• Neoadjuvant therapy, including chemotherapy and chemoradiation, is a cornerstone in managing LAGC.
• Accurate prediction of relapse risk is crucial for optimizing patient outcomes.

Purpose of the Study:

• To assess the long-term survival outcomes in LAGC patients undergoing neoadjuvant treatment and surgery.
• To develop a predictive algorithm for estimating individual relapse risk in a population-based setting.

Main Methods:

• Retrospective analysis of 48 LAGC patients (cT3-4 and/or N+) treated between 2010 and 2024.
• Pathological response and nodal regression were graded using established criteria (Becker criteria, 4-point scale).
• Logistic regression was employed to build a predictive model using 155 patient variables.

Main Results:

• Median follow-up was 49 months; 5-year Progression-Free Survival (PFS) and Overall Survival (OS) were 44% and 48%, respectively.
• A predictive model was developed using four key variables, achieving high accuracy (0.79), sensitivity (0.74), and specificity (0.88) in training.
• Validation dataset showed comparable performance: accuracy 0.78, sensitivity 0.88, specificity 0.73.

Conclusions:

• The neoadjuvant treatment strategy shows potential for favorable long-term outcomes in select LAGC patients.
• Achieving ypN0 status post-neoadjuvant therapy is associated with improved prognosis in intestinal-type LAGC.
• The developed predictive model can aid in risk stratification and personalized treatment planning for LAGC.