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Esophageal Cancer Research and Treatment / Gastrointestinal Tumor Research and Treatment / Gastric Cancer Management and Outcomes · Journal article
BMC Gastroenterology · September 5, 2026
Well-designed and adequately powered for the question it asks.
This network meta-analysis of 36 RCTs found that chemotherapy plus immunotherapy (CHEMO+IO) demonstrated superior overall survival, event-free survival, and pathological response compared with surgery-based control and standard chemotherapy regimens in resectable locally advanced gastric and gastroesophageal junction adenocarcinoma. Postoperative complication rates did not differ significantly, but the analysis relied on indirect comparisons and heterogeneous trial populations, so treatment selection should incorporate direct evidence, biomarkers, and patient fitness.
Systematic review and network meta-analysis of randomized controlled trials. Randomized controlled trials enrolling patients with resectable locally advanced gastric cancer and gastroesophageal junction adenocarcinoma treated with neoadjuvant or perioperative systemic therapy.. Intervention: Neoadjuvant or perioperative systemic therapy treatment classes: chemotherapy plus immunotherapy (CHEMO+IO), chemotherapy plus targeted therapy (CHEMO+TAR), taxane-based triplet chemotherapy (TAX3), platinum-fluoropyrimidine doublet chemot…. Compared with: Surgery-based control (SBC) and individual chemotherapy regimens.. n = 8,925.
CHEMO+IO achieved highest SUCRA values for OS (97.9%) and EFS (92.9%) across all treatment classes CHEMO+IO versus surgery-based control: OS HR 0.50 (95% CI 0.36–0.70) and EFS HR 0.52 (95% CI 0.36–0.76) CHEMO+IO versus platinum-fluoropyrimidine doublet chemotherapy for pCR: OR 4.83 (95% CI 3.20–7.29)
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
Clinicians should consider chemotherapy plus immunotherapy as a favorable treatment class for resectable locally advanced gastric and gastroesophageal junction adenocarcinoma, as it demonstrated superior survival and pathological outcomes without increased postoperative complications. However, treatment selection must incorporate direct trial evidence, biomarker status, patient fitness, and treatment feasibility rather than relying on this network ranking alone.
Network meta-analysis of 36 RCTs with 8925 patients comparing defined treatment classes for resectable locally advanced gastric cancer, with consistent superiority of chemotherapy plus immunotherapy across survival and pathological endpoints, but limited by indirect comparisons and heterogeneous trial populations.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians should consider chemotherapy plus immunotherapy as a favorable treatment class for resectable locally advanced gastric and gastroesophageal junction adenocarcinoma, as it demonstrated superior survival and pathological outcomes without increased postoperative complications. However, treatment selection must incorporate direct trial evidence, biomarker status, patient fitness, and treatment feasibility rather than relying on this network ranking alone.
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.
The optimal neoadjuvant or perioperative systemic strategy for resectable locally advanced gastric cancer (LAGC) and gastroesophageal junction adenocarcinoma (GEJA) remains uncertain. This study compared clinically defined treatment classes rather than individual regimens. PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science were searched through April 30, 2026. Eligible randomized controlled trials (RCTs) enrolled patients with resectable LAGC/GEJA and evaluated neoadjuvant or perioperative systemic therapy. Outcomes were overall survival (OS), event free survival (EFS), pathologic complete response (pCR), major pathologic response (MPR), R0 resection, and postoperative complications. Network meta-analysis pooled hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs). Sensitivity analyses examined clinically refined treatment node definitions. Thirty six RCTs involving 8925 patients were included. Fifteen trials contributed to OS, 19 to EFS, 18 to pCR, 11 to MPR, 34 to R0 resection, and 24 to postoperative complications. Chemotherapy plus immunotherapy (CHEMO + IO) had the highest SUCRA values for OS and EFS (97.9% and 92.9%, respectively). Compared with surgery based control (SBC), CHEMO + IO was associated with improved OS (HR, 0.50; 95% CI, 0.36 to 0.70) and EFS (HR, 0.52; 95% CI, 0.36 to 0.76). For pCR, CHEMO + IO was superior to taxane based triplet chemotherapy (TAX3) (OR, 3.33; 95% CI, 2.30 to 4.83), platinum fluoropyrimidine doublet chemotherapy (PF2) (OR, 4.83; 95% CI, 3.20 to 7.29), and anthracycline based chemotherapy (ACT) (OR, 9.94; 95% CI, 3.90 to 25.34). CHEMO + IO improved MPR versus PF2 (OR, 2.54; 95% CI, 1.32 to 4.91). Chemotherapy plus targeted therapy (CHEMO + TAR) and CHEMO + IO were associated with higher odds of R0 resection than SBC (OR, 3.47; 95% CI, 1.78 to 6.74; and OR, 2.98; 95% CI, 1.55 to 5.72, respectively). Postoperative complications did not differ significantly. Sensitivity analyses using refined node definitions generally supported these findings. Based on network estimates and SUCRA rankings, CHEMO + IO showed favorable treatment class signals across survival and pathological outcomes without a clear increase in postoperative complications. These findings should be interpreted in light of the certainty and directness of the available evidence and do not establish a universal treatment hierarchy. Treatment selection should consider direct trial evidence, efficacy, safety, biomarkers, patient fitness, and treatment feasibility. PROSPERO registration number: CRD420261410576.
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