Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Gastrointest Oncol. Dec 15, 2026; 18(12): 125732
Published online Dec 15, 2026. doi: 10.4251/wjgo.125732
Neoadjuvant chemotherapy vs chemoradiotherapy for locally advanced gastric cancer: A propensity score-matched study
Yi-Fan Wang, Xia-Xi Qiao, Quan-Ming Liu, Yong-Wen Song, Hui Fang, Bo Chen, Ning-Ning Lu, Shu-Nan Qi, Hao Jing, Shu-Lian Wang, Ye-Xiong Li, Jing Jin, Yuan Tang, Ning Li
Yi-Fan Wang, Xia-Xi Qiao, Quan-Ming Liu, Yong-Wen Song, Hui Fang, Bo Chen, Ning-Ning Lu, Shu-Nan Qi, Hao Jing, Shu-Lian Wang, Ye-Xiong Li, Jing Jin, Yuan Tang, Ning Li, Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Jing Jin, Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, Guangdong Province, China
Ning Li, Department of Radiation Oncology, Shanxi Province Cancer Hospital Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences Cancer Hospital Affiliated to Shanxi Medical University Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan 030013, Shanxi Province, China
Co-corresponding authors: Yuan Tang and Ning Li.
Author contributions: Wang YF designed the research study, implemented the study, and drafted the manuscript; Qiao XX and Liu QM performed the data analysis; Song YW, Fang H, Chen B, Lu NN, Qi SN, Jing H, and Wang SL acquired the clinical data and provided technical support; Li YX, Jin J, Tang Y, and Li N conceptualized the research, provided technical guidance, and critically revised the manuscript; Li N is the corresponding author, and Tang Y is the co-corresponding author; all authors have read and approved the final version to be published.
AI contribution statement: AI tools, specifically ChatGPT 4.0, were used solely for language polishing and formatting assistance. No AI tool was used to generate research data, interpret results, or formulate conclusions. All AI-assisted content was critically reviewed and revised by the authors, who take full responsibility for the accuracy, originality, and integrity of the manuscript.
Supported by the National Cancer Center Climbing Fund, No. NCC202414002.
Institutional review board statement: The study was reviewed and approved by the Institutional Ethics Committee of Cancer Hospital, Chinese Academy of Medical Sciences (No. 26/039-5764) on January 15, 2026. This approval explicitly covered the retrospective use of these previously collected data, which were accessed and analyzed only thereafter. All procedures were performed in accordance with the ethical standards of the Declaration of Helsinki.
Informed consent statement: The Institutional Review Board (IRB) reviewed and approved this study with a waiver of informed consent, because the research only analyzed anonymized existing medical records, without additional clinical interventions or direct contact with patients.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset are available from the corresponding author at
lee_ak@163.com.
Corresponding author: Ning Li, MD, Full Professor, Department of Radiation Oncology, Shanxi Province Cancer Hospital Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences Cancer Hospital Affiliated to Shanxi Medical University Cancer Hospital Affiliated to Shanxi Medical University, No. 3 Zhigongxin Street, Taiyuan 030013, Shanxi Province, China.
lee_ak@163.com
Received: July 15, 2026
Revised: September 7, 2026
Accepted: October 30, 2026
Published online: December 15, 2026
Processing time: 118 Days and 3.5 Hours
BACKGROUND
Neoadjuvant therapy has been shown to improve R0 resection rates and enhance pathological responses in patients with locally advanced gastric cancer (LAGC). However, the impact of neoadjuvant chemoradiotherapy (nCRT) on postoperative complications remains debated.
AIM
To investigate whether nCRT affects postoperative complications and perioperative outcomes compared with neoadjuvant chemotherapy (nCT) in patients with LAGC.
METHODS
This retrospective, single-center study included patients with LAGC who received neoadjuvant therapy followed by curative gastrectomy between January 2018 and December 2023. All data were accessed and analyzed only following ethics approval. After propensity score matching, 99 patients were included in the analysis: 25 who received nCRT and 74 who received nCT. Postoperative complications, pathological responses, and perioperative outcomes were compared between the two groups.
RESULTS
There were no significant differences between the nCRT and nCT groups in overall postoperative complications during hospitalization [48.0% vs 47.3%; odds ratio (OR) = 1.02, 95% confidence interval (CI): 0.39-2.71; P = 0.967] or severe complications (Clavien-Dindo grade ≥ 3a; 12.0% vs 13.5%; OR = 0.89, 95%CI: 0.23-3.46; P = 0.866). The analysis identified no statistically significant independent factors associated with postoperative complications. Compared with the nCT group, the nCRT group had a significantly higher pathological complete response rate (36.0% vs 8.1%; OR = 9.87, 95%CI: 2.08-46.80; P = 0.004) and a higher proportion of patients with favorable tumor regression grade (1-2) (60.0% vs 27.0%; OR = 5.44, 95%CI: 1.72-17.23; P = 0.004).
CONCLUSION
Compared with nCT, nCRT showed no statistically significant difference in postoperative complications but was associated with significantly higher pathological responses in patients with LAGC.
Core Tip: Using propensity score matching, this study compared neoadjuvant chemoradiotherapy (nCRT) with neoadjuvant chemotherapy in locally advanced gastric cancer (LAGC), focusing on postoperative complications and pathological outcomes. No statistically significant difference in postoperative complications was observed between the two groups, whereas nCRT was associated with significantly higher pathological complete response and favorable tumor regression rates (1-2). These findings suggest that nCRT is a feasible neoadjuvant strategy for LAGC and may provide improved pathological responses, warranting further prospective evaluation.
