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Background <p>Neoadjuvant therapy (NAT) effectively downstages locally advanced gastric cancer (LAGC), increasing the proportion of patients achieving ypTNM stage 0–I. However, it is still controversial whether the LAGC patients with better tumor regression (ypTNM stage 0–I) had similar prognosis compared with pTNM I early gastric cancer (EGC) patients or not. This study compared short- and long-term outcomes between ypTNM 0-I LAGC and EGC patients.</p> Methods <p>A retrospective analysis of 1,193 patients with pTNM I EGC or ypTNM 0-I LAGC treated between January 2020 and November 2024 from three medical centers was conducted. Propensity score matching (PSM) at a 1:1 ratio balanced baseline characteristic. Short- and long-term outcomes were compared between groups.</p> Results <p>After PSM, baseline characteristics were comparable with no significant difference (<i>P</i> &gt; 0.05). The ypTNM 0-I group had longer operative times, greater estimated blood loss, and extended postoperative hospital days compared with pTNM I group (<i>P</i> &lt; 0.05), but no differences in complication rates, recurrence rates, 3-year overall survival (OS: 93.3% vs. 90.1%, <i>P</i> = 0.608) and recurrence-free survival (RFS: 90.3% vs. 87.7%, <i>P</i> = 0.301) between two groups. Multivariable Cox analysis identified nerve invasion as an independent risk factor for OS and RFS, while preoperative CEA ≥ 2.5&#xa0;ng/mL was associated with poorer RFS (<i>P</i> &lt; 0.05).</p> Conclusion <p>LAGC patients achieving ypTNM 0-I after NAT had comparable short- and long-term outcomes to pTNM I EGC patients. Nerve invasion and CEA levels ≥ 2.5&#xa0;ng/mL were prognostic indicators for poorer survival.</p>

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Therapeutic efficacy and oncological prognosis of ypTNM 0-I gastric cancer after neoadjuvant therapy: a multicenter propensity-score matched study in China

  • 期刊论文

  • 发表日期：

    2025年12月17日

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  • Hao Cui,
  • Yuyuan Lu,
  • Huiguang Ren,
  • Liqiang Song,
  • Zhen Yuan,
  • Yuchen Liu,
  • Rui Li,
  • Lin Chen,
  • Canrong Lu,
  • Jianxin Cui,
  • Bo Wei

摘要

Background

Neoadjuvant therapy (NAT) effectively downstages locally advanced gastric cancer (LAGC), increasing the proportion of patients achieving ypTNM stage 0–I. However, it is still controversial whether the LAGC patients with better tumor regression (ypTNM stage 0–I) had similar prognosis compared with pTNM I early gastric cancer (EGC) patients or not. This study compared short- and long-term outcomes between ypTNM 0-I LAGC and EGC patients.

Methods

A retrospective analysis of 1,193 patients with pTNM I EGC or ypTNM 0-I LAGC treated between January 2020 and November 2024 from three medical centers was conducted. Propensity score matching (PSM) at a 1:1 ratio balanced baseline characteristic. Short- and long-term outcomes were compared between groups.

Results

After PSM, baseline characteristics were comparable with no significant difference (P > 0.05). The ypTNM 0-I group had longer operative times, greater estimated blood loss, and extended postoperative hospital days compared with pTNM I group (P < 0.05), but no differences in complication rates, recurrence rates, 3-year overall survival (OS: 93.3% vs. 90.1%, P = 0.608) and recurrence-free survival (RFS: 90.3% vs. 87.7%, P = 0.301) between two groups. Multivariable Cox analysis identified nerve invasion as an independent risk factor for OS and RFS, while preoperative CEA ≥ 2.5 ng/mL was associated with poorer RFS (P < 0.05).

Conclusion

LAGC patients achieving ypTNM 0-I after NAT had comparable short- and long-term outcomes to pTNM I EGC patients. Nerve invasion and CEA levels ≥ 2.5 ng/mL were prognostic indicators for poorer survival.