Survival and Pathologic Response After Neoadjuvant Treatment in Esophagogastric Cancer: A Systematic Review
In brief
Immunotherapy-boosted neoadjuvant therapy yields complete pathological response in roughly half of esophagogastric cancers
A systematic review of 60 recent studies found that adding immunotherapy to chemoradiotherapy or chemotherapy raised pathological complete response rates to 48-50%, compared with 22-33% for non-immune regimens. Patients achieving complete or major tumor regression consistently lived longer, but response varied by tumor type and treatment details, underscoring the need for standardized assessment and biomarker guidance.
- Journal
- Diagnostics (Basel, Switzerland) (Q2)
- Published
- 11 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Raluca-Elena Marica, Adelina Băloi, Marius Păpurică, Ciprian-Mihai Gândac, Claudiu-Rafael Bârsac, Justin-Ștefan Paraschiv, et al.
- PMID
- 42650927
- DOI
- 10.3390/diagnostics16162524
Why clinicians should know about it
- Picked for Biochemistry (medical) (top studies of the week, 30 August 2026).
- Picked for Histology (top studies of the week, 30 August 2026): High-quality evidence in a top journal
- Picked for Pathology and Forensic Medicine (top studies of the week, 30 August 2026).
Abstract
Background: Esophagogastric cancer (EGC), encompassing oesophageal, gastroesophageal junction (GEJ), and proximal gastric malignancies, remains a major contributor to global cancer mortality. Neoadjuvant therapy, chemotherapy (CT) or chemoradiotherapy (CRT) is now standard for locally advanced, resectable disease. However, variability in treatment response and survival outcomes continues to challenge therapeutic optimisation. Methods: This systematic review followed the PRISMA 2020 guidelines and included studies published between January 2020 and September 2025. Eligible studies enrolled adult patients with resectable EGC treated with neoadjuvant CT or CRT, reporting data on pathological response (pathological complete response (pCR) or tumour regression grade (TRG)) and survival outcomes [overall survival (OS), disease-free survival (DFS)]. Sixty studies (18 randomised controlled trials and 42 cohort analyses) were included for qualitative synthesis. Results: Across all regimens, pCR rates ranged from 8% to 49%, with CRT achieving higher pCR (mean 33%) and major TRG response (63%) compared to CT alone (pCR 22%, TRG 48%). Immunotherapy-enhanced protocols (IO-CRT and IO-CT) demonstrated the most promising outcomes, reaching mean pCR rates up to 48-50%. Patients with complete or major regression consistently achieved superior OS and DFS, confirming pathological response as a consistent prognostic marker for long-term survival. Significant clinical heterogeneity was observed across histological subtypes (SCC vs. AC), treatment intensity, and surgical timing, while methodological heterogeneity stemmed from variations in TRG systems, follow-up duration, and reporting standards. Conclusions: Pathological response is consistently associated with survival following neoadjuvant therapy in EGC, yet its predictive power is modulated by tumour histology and treatment modality. Standardisation of TRG assessment, integration of molecular biomarkers, and harmonisation of study design are essential for improving comparability and advancing personalised, multimodal strategies in oesophagogastric oncology.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.