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Metastasis and Carcinoma Case Studies / Gastric Cancer Management and Outcomes · Journal article
Frontiers in Immunology · August 12, 2026
Encouraging direction, but not yet definitive.
This single-center retrospective cohort study of 133 patients with gastric cancer and para-aortic lymph node metastasis reports substantially higher pathological complete response (37.1% vs. 4.2%), major pathological response (58.1% vs. 22.5%), and 3-year overall survival (64.5% vs. 42.3%) with perioperative PD-1 inhibitor plus chemotherapy compared to chemotherapy alone. However, the retrospective, non-randomized design, single-center setting, and lack of adjustment for potential confounders limit the strength of inference; these results are hypothesis-generating and require prospective, multicenter validation.
Single-center retrospective cohort study. Patients with gastric cancer and para-aortic lymph node (No.16a2/b1) metastasis undergoing perioperative systemic therapy with D2 gastrectomy plus para-aortic node dissection (PAND); treated at a single center between January 2018 and February 2024.. Intervention: Chemotherapy plus PD-1 inhibitor (perioperative regimen, agent and dosing not specified in abstract).. Compared with: Chemotherapy alone (perioperative regimen, agent and dosing not specified in abstract).. n = 133. Single center; specific location not stated..
Pathological complete response: 37.1% (Group A, PD-1 inhibitor plus chemotherapy) vs. 4.2% (Group B, chemotherapy alone), P<0.001 Major pathological response: 58.1% (Group A) vs. 22.5% (Group B), P<0.001 3-year overall survival rate: 64.5% (Group A) vs. 42.3% (Group B)
No treatment-related deaths; adverse event incidence comparable between groups
If validated in prospective multicenter trials, perioperative PD-1 inhibitor plus chemotherapy could become standard for gastric cancer with para-aortic nodal involvement. Clinicians should not adopt this regimen based on this single retrospective study, but should monitor ongoing trials and consider enrollment of eligible patients in prospective comparative studies.
A single-center retrospective cohort study shows higher pathological response and 3-year OS with PD-1 inhibitor plus chemotherapy versus chemotherapy alone in gastric cancer with para-aortic node metastasis, but lacks randomization, prospective design, and multicenter validation.
As stated by the source record.
Quoted from the source exactly as published.
If validated in prospective multicenter trials, perioperative PD-1 inhibitor plus chemotherapy could become standard for gastric cancer with para-aortic nodal involvement. Clinicians should not adopt this regimen based on this single retrospective study, but should monitor ongoing trials and consider enrollment of eligible patients in prospective comparative studies.
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.
Objectives Research on the efficacy of perioperative immunotherapy for gastric cancer with para-aortic lymph node (PAN) metastasis remains limited. This study aimed to compare the safety and efficacy of chemotherapy plus programmed cell death protein-1 (PD-1) inhibitor versus chemotherapy alone in locally advanced GC patients with PAN metastasis. Methods We retrospectively reviewed patients with gastric cancer and limited No.16a2/b1 lymph node metastasis who received perioperative systemic therapy combined with D2 gastrectomy plus PAN dissection (PAND) between January 2018 and February 2024. Patients were divided into Group A (chemotherapy+PD-1 inhibitor, n=62) and Group B (chemotherapy alone, n=71). Pathological response, survival outcomes, and safety were evaluated. Results All patients in Group A achieved R0 resection, compared with 98.6% in Group B. Pathological outcomes were significantly better in Group A, with higher rates of pathological complete response (pCR; 37.1% vs. 4.2%, P 0.001) and major pathological response (MPR; 58.1% vs. 22.5%, P 0.001) compared to Group B. In Group A, patients with programmed death ligand-1 (PD-L1) combined positive score (CPS) ≥5 had higher pCR rates. The 3-year overall survival (OS) rate was also higher in Group A (64.5% vs. 42.3%). The median OS for Group B was 33.2 months, while Group A was not reached (P = 0.023). Adverse event incidences were comparable between groups, with no treatment-related deaths. Conclusion Perioperative immunochemotherapy significantly enhances pathological response and survival in GC patients with PAN metastasis, with manageable safety. This regimen represents a promising therapeutic strategy for this patient population, necessitating long-term follow-up to confirm durable benefits.
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