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Objective <p>This study aimed to evaluate the prognostic significance of the Modified Ryan Tumor Regression Score (TRG) in predicting overall survival (OS) and disease-free survival (DFS) among patients with locally advanced gastric and gastroesophageal junction (GEJ) adenocarcinomas treated with neoadjuvant FLOT chemotherapy (5-fluorouracil, leucovorin, oxaliplatin, and docetaxel). We aimed to evaluate whether the modified Ryan TRG independently predicts DFS and OS in a homogeneous FLOT-treated cohort.</p> Materials and methods <p>Patients with locally advanced gastric or GEJ adenocarcinomas who received neoadjuvant FLOT and underwent curative surgery were retrospectively reviewed. The Modified Ryan TRG was categorized into four grades (0–3) according to the proportion of residual viable tumor cells.</p> Results <p>A total of 154 patients were included in the analysis. Among all patients, 26.6% achieved a good pathological response (TRG 0–1), 24.7% had a partial response (TRG 2), and 48.7% showed minimal or no response (TRG 3). Median DFS and OS were not reached in the TRG 0–1 group, whereas they were 16.1 and 29.9&#xa0;months, respectively, in the TRG 3 group (<i>p</i> &lt; 0.001). Lower TRG (0–1) independently predicted improved DFS (HR = 0.07, <i>p</i> &lt; 0.001) and OS (HR = 0.10, <i>p</i> = 0.002).</p> Conclusion <p>The Modified Ryan Tumor Regression Score represents a strong and independent prognostic indicator in patients with locally advanced gastric and GEJ adenocarcinomas treated with the FLOT regimen. Patients with low TRG (0–1) scores exhibit superior survival outcomes, while those with high TRG (3) scores may benefit from closer follow-up and intensified adjuvant strategies. Prospective studies are warranted to validate TRG-based individualized treatment approaches.</p>

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Prognostic ımpact of the modified Ryan tumor regression score in gastric and GEJ adenocarcinomas treated with neoadjuvant FLOT regimen

  • 期刊论文

  • 发表日期：

    2026年3月18日

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  • Mehmet Akif Parlar,
  • Burak Bilgin,
  • Bülent Yalçın,
  • Efnan Algın,
  • Öznur Bal,
  • Serhat Sekmek,
  • Furkan Ceylan,
  • Mehmet Ali Nahit Şendur

摘要

Objective

This study aimed to evaluate the prognostic significance of the Modified Ryan Tumor Regression Score (TRG) in predicting overall survival (OS) and disease-free survival (DFS) among patients with locally advanced gastric and gastroesophageal junction (GEJ) adenocarcinomas treated with neoadjuvant FLOT chemotherapy (5-fluorouracil, leucovorin, oxaliplatin, and docetaxel). We aimed to evaluate whether the modified Ryan TRG independently predicts DFS and OS in a homogeneous FLOT-treated cohort.

Materials and methods

Patients with locally advanced gastric or GEJ adenocarcinomas who received neoadjuvant FLOT and underwent curative surgery were retrospectively reviewed. The Modified Ryan TRG was categorized into four grades (0–3) according to the proportion of residual viable tumor cells.

Results

A total of 154 patients were included in the analysis. Among all patients, 26.6% achieved a good pathological response (TRG 0–1), 24.7% had a partial response (TRG 2), and 48.7% showed minimal or no response (TRG 3). Median DFS and OS were not reached in the TRG 0–1 group, whereas they were 16.1 and 29.9 months, respectively, in the TRG 3 group (p < 0.001). Lower TRG (0–1) independently predicted improved DFS (HR = 0.07, p < 0.001) and OS (HR = 0.10, p = 0.002).

Conclusion

The Modified Ryan Tumor Regression Score represents a strong and independent prognostic indicator in patients with locally advanced gastric and GEJ adenocarcinomas treated with the FLOT regimen. Patients with low TRG (0–1) scores exhibit superior survival outcomes, while those with high TRG (3) scores may benefit from closer follow-up and intensified adjuvant strategies. Prospective studies are warranted to validate TRG-based individualized treatment approaches.