mTLS status predicts survival benefit from adjuvant chemotherapy in gastric cancer patients treated with neoadjuvant therapy and surgery
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background: The impact of adjuvant chemotherapy (ACT) on gastric cancer (GC) patients receiving neoadjuvant chemotherapy (NACT) remains unclear. This study aims to evaluate the effect of ACT on survival in patients undergoing curative surgery after NACT. Methods: Clinical and pathological data of GC patients treated with NACT followed by radical surgery were retrospectively collected. Patients were categorized according to ACT administration. Propensity score matching (PSM) was employed to compare the prognosis between those who received ACT and those who did not. Results: After cohort selection and PSM, 180 patients with locally advanced GC were included: 116 in the ACT group and 64 in the no ACT group. No significant difference in overall survival (OS) was observed between the two groups (P=0.46). Subgroup analyses based on tumor invasion depth, lymph node metastasis, histological subtype, lymphovascular invasion (LVI), perineural invasion (PNI), and tumor regression grade (TRG) revealed no significant OS benefit from ACT in any subgroup. In a smaller cohort subset, among patients lacking mature tertiary lymphoid structures (mTLSs) in the tumor bed, the ACT group exhibited a higher OS rate compared with the no ACT group (P=0.006). Conversely, among patients with mTLSs, the no-ACT group demonstrated better survival (P=0.02). Likelihood ratio tests and multivariate Cox regression analysis indicated that the effect of ACT on OS depends on mTLS status. In subgroups stratified by mTLS status, ACT was identified as an independent prognostic factor. Conclusions: For patients with locally advanced GC treated with NACT, ACT does not confer a significant survival benefit in the overall population. The presence of mTLSs following NACT serves as a strong predictive biomarker for ACT efficacy. Patients without mTLSs in the tumor bed after NACT may derive greater benefit from ACT.
Authors: Dan Liu, Chenyu Tian, Bosen Li, Xinyou Liu, Chengbo Ji, Yihong Sun, Junjie Zhao, Haojie Li, Xuefei Wang
Institutions: Fudan University, Zhongshan Hospital
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7117464278