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Background <p>The optimal extent of gastrectomy after neoadjuvant therapy for Siewert II/III gastric adenocarcinoma remains unclear.</p> <p>The objective of this study was to compare survival after proximal versus total gastrectomy and to assess the prognostic impact of distal nodal station metastasis (nos. 4d, 5, 6, and 12a).</p> Patients and Methods <p>We retrospectively analyzed 824 patients with Siewert II/III gastric adenocarcinoma who received neoadjuvant chemotherapy and underwent proximal gastrectomy (PG) or total gastrectomy (TG) at three Chinese centers (2010–2025). Following propensity score matching, survival analysis was performed on a balanced cohort of 518 patients. Overall survival (OS) and progression-free survival (PFS) were assessed using Kaplan–Meier analysis and Cox regression.</p> Results <p>PG and TG achieved comparable OS and PFS (OS <i>P</i> = 0.54; PFS <i>P</i> = 0.86), with consistent findings across Siewert subtype, pathologic T stage, and TNM stage strata. No significant differences were observed in N0 or N<sup>+</sup> subgroups. Survival remained similar between procedures regardless of neoadjuvant response or immunotherapy exposure. Metastasis to distal lymph node stations increased with advancing ypTNM stage, particularly in stage III disease. In multivariable analyses, gastrectomy type was not an independent prognostic factor (<i>P</i> = 0.117), whereas advanced pathological stage independently predicted worse survival (all <i>P</i> &lt; 0.05). Other clinicopathologic variables were not independently associated with outcome.</p> Conclusions <p>PG provides survival comparable to TG after neoadjuvant therapy. The distal key station exhibits a significantly higher metastatic incidence in patients with stage III gastric cancer.</p>

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Survival Comparison of Proximal and Total Gastrectomy after Neoadjuvant Therapy in Siewert Type II/III Gastric Adenocarcinoma: A Real-World Multicenter Cohort Study

  • 期刊论文

  • 发表日期：

    2026年6月14日

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  • Ze-Lin Wen,
  • Hu Ren,
  • Peng-Hui Niu,
  • Xiao-Jie Zhang,
  • He Fei,
  • Dong-Shuai Jing,
  • Ze-Feng Li,
  • Diliyaer Adili,
  • Hong-Xu Nie,
  • Lei Zhou,
  • De-Chun Liu,
  • Dong-Bing Zhao

摘要

Background

The optimal extent of gastrectomy after neoadjuvant therapy for Siewert II/III gastric adenocarcinoma remains unclear.

The objective of this study was to compare survival after proximal versus total gastrectomy and to assess the prognostic impact of distal nodal station metastasis (nos. 4d, 5, 6, and 12a).

Patients and Methods

We retrospectively analyzed 824 patients with Siewert II/III gastric adenocarcinoma who received neoadjuvant chemotherapy and underwent proximal gastrectomy (PG) or total gastrectomy (TG) at three Chinese centers (2010–2025). Following propensity score matching, survival analysis was performed on a balanced cohort of 518 patients. Overall survival (OS) and progression-free survival (PFS) were assessed using Kaplan–Meier analysis and Cox regression.

Results

PG and TG achieved comparable OS and PFS (OS P = 0.54; PFS P = 0.86), with consistent findings across Siewert subtype, pathologic T stage, and TNM stage strata. No significant differences were observed in N0 or N+ subgroups. Survival remained similar between procedures regardless of neoadjuvant response or immunotherapy exposure. Metastasis to distal lymph node stations increased with advancing ypTNM stage, particularly in stage III disease. In multivariable analyses, gastrectomy type was not an independent prognostic factor (P = 0.117), whereas advanced pathological stage independently predicted worse survival (all P < 0.05). Other clinicopathologic variables were not independently associated with outcome.

Conclusions

PG provides survival comparable to TG after neoadjuvant therapy. The distal key station exhibits a significantly higher metastatic incidence in patients with stage III gastric cancer.