Association of Adjuvant Immunotherapy With Survival Outcomes Among Patients With Locally Advanced Gastric Cancer After Neoadjuvant Immunochemotherapy: A Propensity Score-Matched Cohort Study
In brief
Postoperative immunotherapy adds side effects, not survival benefit, in matched gastric cancer patients
In a propensity-matched cohort of 188 patients with locally advanced gastric cancer, adding immunotherapy after surgery did not improve 3-year disease-free or overall survival compared with chemotherapy alone. Immune-related side effects were more common with immunotherapy, affecting 43.6% versus 27.7%; randomized trials are still needed to confirm whether any subgroup benefits.
- Journal
- Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract (Q1)
- Published
- 30 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Weijun Zhang, Zhuoyu Jia, Qi Liu, Wenqiao Zhou, Zhongxuan Li, Yuntong Liang, et al.
- PMID
- 42815617
- DOI
- 10.1016/j.gassur.2026.102618
Why clinicians should know about it
- Picked for Gastrointestinal and Colorectal Surgery (paper of the day, 3 October 2026): Adjuvant immunotherapy vs chemo in gastric cancer
Abstract
BACKGROUND: For patients with locally advanced gastric cancer (LAGC) who have received neoadjuvant immunochemotherapy (NAIC), it has been recognized that adjuvant chemotherapy after operation is indispensable for the majority of cases; nevertheless, whether additional postoperative adjuvant immunotherapy is needed is still an unanswered question. METHODS: A total of 233 LAGC patients who received NAIC were included in this study, of which 115 patients received adjuvant immunochemotherapy (AIC) and 118 patients received adjuvant chemotherapy (AC) only. After propensity score matching (PSM) for 1:1 matching, 94 patients were included in both the AC and AIC groups. Immune-related adverse events (irAEs), 3-year disease-free survival (DFS) and overall survival (OS) outcomes were compared between the two groups of patients. RESULTS: After PSM, 188 patients were included in the study. AIC group did not demonstrate a significant advantage in terms of 3-year DFS (AC: 77.6% vs. AIC: 75.5%, P=0.534) and 3-year OS (AC: 88.2% vs. AIC: 86.1%, P=0.593) compared to the AC group. However, the total number of irAEs in the AIC group was significantly higher than that in the AC group (AC: 27.66% vs. AIC: 43.62%, P = 0.021). CONCLUSION: For LAGC patients after NAIC, postoperative adjuvant immunotherapy may not be warranted for most patients across all ypTNM stages, pending validation from prospective randomized controlled trials.
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.