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Assessing Graded Histological Regression as Basis for Treatment Modification after Neoadjuvant Therapy in LAGC: An
Dongfeng Song1, Yajie Rong1, Yining Fu2
1Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Annals of Surgical Oncology
|August 7, 2026
Summary
For locally advanced gastric cancer (LAGC) patients with poor response to neoadjuvant chemotherapy, a graded histologic regression (GHR) less than 50% suggests modifying adjuvant chemotherapy. This adjustment improved disease-free survival and overall survival in a phase II trial.
Area of Science:
- Oncology
- Gastroenterology
- Clinical Trials
Background:
- Adjuvant chemotherapy regimen modification after ineffective neoadjuvant chemotherapy in locally advanced gastric cancer (LAGC) is not well-defined.
- Graded histologic regression (GHR) < 50% is explored as a potential indicator for changing adjuvant treatment.
Purpose of the Study:
- To investigate if GHR < 50% can guide adjuvant chemotherapy regimen modification in LAGC patients.
- To evaluate the impact of modified adjuvant chemotherapy on disease-free survival (DFS) and overall survival (OS).
Main Methods:
- A prospective, single-center, randomized phase II trial involving 58 LAGC patients with postoperative GHR < 50%.
- Patients were assigned to either a paclitaxel-modified adjuvant regimen (Group A) or the original regimen (Group B).
- Primary endpoint was DFS; secondary endpoints included OS and safety.
Main Results:
- Modified adjuvant chemotherapy (Group A) resulted in significantly longer median DFS (25.2 vs. 11.4 months) and OS (32.0 vs. 18.0 months) compared to the original regimen (Group B).
- Regimen modification was an independent prognostic factor for improved DFS and OS.
- Patients with ypN3 stage and ypTNM III stage showed particular benefit from regimen modification.
Conclusions:
- A GHR < 50% may signal the need for adjuvant chemotherapy regimen adjustment in LAGC.
- Further large-scale studies are required to confirm the survival benefits of this strategy.
