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Esophageal Cancer Research and Treatment / Gastric Cancer Management and Outcomes · Journal article
Diagnostics · August 11, 2026
Well-designed and adequately powered for the question it asks.
This systematic review of 60 studies (18 RCTs, 42 cohorts) confirms that pathological complete response (pCR) and major tumour regression grade (TRG) are consistent prognostic markers for overall and disease-free survival in patients with resectable esophagogastric cancer treated with neoadjuvant chemotherapy or chemoradiotherapy. However, substantial clinical and methodological heterogeneity—across histological subtypes, treatment intensity, TRG systems, and follow-up protocols—limits direct synthesis and clinically actionable conclusions.
Systematic review. Adult patients with resectable esophagogastric cancer (oesophageal, GEJ, proximal gastric) treated with neoadjuvant chemotherapy or chemoradiotherapy.. Intervention: Neoadjuvant chemotherapy (CT) or chemoradiotherapy (CRT); immunotherapy-enhanced protocols (IO-CRT and IO-CT) also examined..
pCR rates ranged from 8% to 49% across all regimens CRT achieved higher mean pCR (33%) and major TRG response (63%) compared to CT alone (pCR 22%, TRG 48%) Immunotherapy-enhanced protocols (IO-CRT and IO-CT) reached mean pCR rates of 48–50%
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Clinicians should recognize that pathological response (complete or major regression) is a reliable indicator of improved survival in neoadjuvant-treated esophagogastric cancer and may guide prognostication. However, treatment choice between chemotherapy, chemoradiotherapy, and immunotherapy-enhanced protocols, and interpretation of response, should account for histological subtype (squamous cell carcinoma vs. adenocarcinoma) and local practice standards, as the heterogeneity limits universal recommendations.
Systematic review of 60 studies (18 RCTs, 42 cohorts) with consistent evidence that pathological response predicts survival in neoadjuvant-treated esophagogastric cancer, though high clinical heterogeneity limits direct practice guidance.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians should recognize that pathological response (complete or major regression) is a reliable indicator of improved survival in neoadjuvant-treated esophagogastric cancer and may guide prognostication. However, treatment choice between chemotherapy, chemoradiotherapy, and immunotherapy-enhanced protocols, and interpretation of response, should account for histological subtype (squamous cell carcinoma vs. adenocarcinoma) and local practice standards, as the heterogeneity limits universal recommendations.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
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.
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