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Background <p>Neoadjuvant chemotherapy for gastric cancer is assessed by RECIST but overlooks microscopic changes; incorporating CEA dynamics may improve evaluation accuracy.</p> Methods <p>Retrospective analysis of 600 locally advanced gastric cancer (LAGC) patients (training:457; validation:143) from nine tertiary hospitals. The Biochemical and Radiologic Response System (BRRS) integrated RECIST 1.1-stratified radiological responses and peri-NAT carcinoembryonic antigen (CEA) dynamics. Predictive performance was evaluated using receiver operating characteristic (ROC) curves(AUC), time-dependent ROC, Akaike(AIC) and Bayesian(BIC) information criteria.</p> Results <p>The BRRS was developed through Kaplan–Meier analysis of biochemical/radiologic responses to NACT, classifying 457 training-cohort patients into dual (DR, <i>n</i> = 168), single (SR, <i>n</i> = 185), and no responders (NR, <i>n</i> = 104).Three-year overall survival (OS) rates were 74.4% (DR), 60.6% (SR), and 35.0% (NR) (all <i>P</i> &lt; 0.001). ypTNM 3-year OS rates were 96.4% (stage 0), 82.1% (stage I), 72.7% (stage II), 42.5% (stage III) (I vs. 0: <i>P</i> = 0.405; II vs. I: <i>P</i> = 0.122; III vs. II: <i>P</i> &lt; 0.001), and tumor regression grade(TRG) 3-year OS rates were 93.6, 74.1, 45.9, 46.7% (TRG1 vs. 0:<i>P</i> = 0.060; TRG2 vs. 1:<i>P</i> = 0.001; TRG3 vs. 2:<i>P</i> = 0.583). BRRS (AUC = 0.708, AIC = 992.57, BIC = 995.20) outperformed ypTNM (AUC = 0.678, AIC = 1007.18, BIC = 1008.81) and TRG (AUC = 0.661, AIC = 1012.03, BIC = 1015.65) in OS prediction. Adjuvant chemotherapy improved OS/disease-free survival (DFS) in SR (OS:62.9 vs. 41.4%, <i>P</i> = 0.041; DFS:55.7 vs. 31.6%, <i>P</i> = 0.020) and NR groups (OS:39.1 vs. 16.7%, P = 0.030; DFS: 36.1 vs. 11.9%, <i>P</i> = 0.019) but not in DR (OS: 75.4 vs. 66.7%, <i>P</i> = 0.765; DFS: 66.7 vs. 71.4%, <i>P</i> = 0.455). The results from the validation cohort were consistent.</p> Conclusion <p>BRRS outperformed conventional ypTNM and TRG systems in prognostication. Postoperative chemotherapy may be omitted in DR patients.</p> Graphical abstract <p></p>

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Can combined biochemical and radiological responses enhance prognostic assessment after neoadjuvant therapy for locally advanced gastric cancer? A multicenter real-world study

  • 期刊论文

  • 发表日期：

    2026年6月17日

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  • Hua-long Zheng,
  • Gang Wang,
  • Bao-long Li,
  • Ling-kang Zhang,
  • Yu-qin Sun,
  • Yong-hong Wang,
  • Ju Wu,
  • Shi-chao Wu,
  • Wei Zhao,
  • Jun-hua Yu,
  • Ji-yun Zhu,
  • Hong-hong Zheng,
  • Cai-ming Weng,
  • Jian-xian Lin,
  • Ji-ao Tang,
  • Jia-bin Wang,
  • Chang-ming Huang

摘要

Background

Neoadjuvant chemotherapy for gastric cancer is assessed by RECIST but overlooks microscopic changes; incorporating CEA dynamics may improve evaluation accuracy.

Methods

Retrospective analysis of 600 locally advanced gastric cancer (LAGC) patients (training:457; validation:143) from nine tertiary hospitals. The Biochemical and Radiologic Response System (BRRS) integrated RECIST 1.1-stratified radiological responses and peri-NAT carcinoembryonic antigen (CEA) dynamics. Predictive performance was evaluated using receiver operating characteristic (ROC) curves(AUC), time-dependent ROC, Akaike(AIC) and Bayesian(BIC) information criteria.

Results

The BRRS was developed through Kaplan–Meier analysis of biochemical/radiologic responses to NACT, classifying 457 training-cohort patients into dual (DR, n = 168), single (SR, n = 185), and no responders (NR, n = 104).Three-year overall survival (OS) rates were 74.4% (DR), 60.6% (SR), and 35.0% (NR) (all P < 0.001). ypTNM 3-year OS rates were 96.4% (stage 0), 82.1% (stage I), 72.7% (stage II), 42.5% (stage III) (I vs. 0: P = 0.405; II vs. I: P = 0.122; III vs. II: P < 0.001), and tumor regression grade(TRG) 3-year OS rates were 93.6, 74.1, 45.9, 46.7% (TRG1 vs. 0:P = 0.060; TRG2 vs. 1:P = 0.001; TRG3 vs. 2:P = 0.583). BRRS (AUC = 0.708, AIC = 992.57, BIC = 995.20) outperformed ypTNM (AUC = 0.678, AIC = 1007.18, BIC = 1008.81) and TRG (AUC = 0.661, AIC = 1012.03, BIC = 1015.65) in OS prediction. Adjuvant chemotherapy improved OS/disease-free survival (DFS) in SR (OS:62.9 vs. 41.4%, P = 0.041; DFS:55.7 vs. 31.6%, P = 0.020) and NR groups (OS:39.1 vs. 16.7%, P = 0.030; DFS: 36.1 vs. 11.9%, P = 0.019) but not in DR (OS: 75.4 vs. 66.7%, P = 0.765; DFS: 66.7 vs. 71.4%, P = 0.455). The results from the validation cohort were consistent.

Conclusion

BRRS outperformed conventional ypTNM and TRG systems in prognostication. Postoperative chemotherapy may be omitted in DR patients.

Graphical abstract