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Siberian journal of oncology

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Multicenter cohort retrospective clinical study assessing the impact of complete pathological tumor response on survival rates in patients with locally advanced gastric and esophagogastric junction cancer: demographic and clinical-morphological characteristics, treatment options and immediate results (report 2)

https://doi.org/10.21294/1814-4861-2026-25-3-5-20

Abstract

Background. Gastric cancer remains one of the leading causes of cancer-related mortality globally and ranks second in Russia. Pathological complete response (pCR, ypT0N0M0) is a significant surrogate marker for the efficacy of neoadjuvant therapy and disease prognosis. Despite accumulating data, the demographic and clinical-morphological characteristics of this patient category, as well as the dependence of pCR on the neoadjuvant therapy regimen, remain insufficiently studied.

Aim: to characterize the demographic and clinical-morphological characteristics, methods and tolerability of perioperative therapy, and features of surgical treatment in a multicenter retrospective cohort of patients with locally advanced gastric and esophagogastric junction cancer, who achieved pCR after neoadjuvant therapy.

Material and Methods. Data from 221 patients with histologically confirmed gastric or esophagogastric junction adenocarcinoma (cT2-4N0-3M0) who achieved pCR (ypT0N0M0) confirmed by pathomorphological examination of the resected specimen were retrospectively analyzed.

Results. The median age was 65 years (range 24-89). Men (52.5 %) and patients with clinical stage iii (48.0 %) and IIB (30.8 %) predominated. Poorly differentiated adenocarcinoma was detected in 124 (56.1 %) patients, and signet ring cell carcinoma in 35 (15.8 %). Lymph node metastasis (cN+) at the time of diagnosis was found in 124 (56.1 %) patients. The completion rate of neoadjuvant chemotherapy was 96.6 %. Grade >3 adverse events were registered in 17 (8.3 %) patients receiving chemotherapy and in 3 (17.6 %) receiving chemoradiotherapy. According to follow-up examination, a complete clinical response was detected in 2 (0.9 %) patients, a partial response in 57 (25.8 %), and disease stabilization in 162 (73.3 %). Adjuvant chemotherapy was administered to 132 (59.7 %) patients (including the FLOT regimen in 75.0 %). The predominant method of surgical treatment was gastrectomy (59.3 %). Postoperative complications occurred in 47 (21.3 %) patients, including Clavien-Dindo grade >iii in 24 (10.9 %); the 30-day postoperative mortality rate was 1.4 %.

Conclusion. Within the clinical study, the largest sample of the Russian population of gastric cancer patients with a registered pathological complete response after neoadjuvant therapy was collected - 221 patients. This cohort is dominated by features associated with aggressive gastric cancer: diffuse and mixed Lauren types; poorly differentiated adenocarcinoma, including signet ring cell carcinoma; clinical categories cT3-4 and cN+. in patients with pCR, the completion rate of neoadjuvant therapy was 96.6 %, with the FLOT regimen being the most frequently used. Routine CT scanning does not reliably diagnose pCR; thus, searching for and validating new standardized biomarkers for the objective assessment of tumor response to neoadjuvant therapy is highly relevant.

About the Authors

V. Yu. Skoropad
A.F. Tsyb Medical Radiological Research Center - branch of the National Medical Research Center of Radiology
Russian Federation

Vitaliy Yu. Skoropad, MD, DSc, Head of the Department of Thoraco-Abdominal Oncology 

Researcher ID (WOS): E-2200-2018

4, Koroleva St., Obninsk, 249031


E. I. Smolenov
A.F. Tsyb Medical Radiological Research Center - branch of the National Medical Research Center of Radiology
Russian Federation

Evgeny I. Smolenov, MD, PhD, Senior Researcher, Division of Thoracic Oncology

4, Koroleva St., Obninsk, 249031


V. N. Grinevich
A.F. Tsyb Medical Radiological Research Center - branch of the National Medical Research Center of Radiology; P.A. Hertsen Moscow Oncology Research Institute - branch of the national Medical Research Center of Radiology
Russian Federation

Vyacheslav N. Grinevich, MD, PhD, President of the Russian Society of Oncopathologists, Head of the Oncopathology Department, A.F. Tsyb Medical Radiological Research Center; Head of the Oncopathology Department, P.A. Hertsen Moscow Oncology Research Institute

4, Koroleva St., Obninsk, 249031; 
3, 2nd Botkinsky Proezd, Moscow, 125284


S. M. Volobuev
A.F. Tsyb Medical Radiological Research Center - branch of the National Medical Research Center of Radiology
Russian Federation

Stanislav M. Volobuev, Resident Physician

4, Koroleva St., Obninsk, 249031


S. V. Gamayunov
Nizhny Novgorod Regional Clinical Oncology Center
Russian Federation

Sergey V. Gamayunov, MD, DSc, Chief External Specialist in Oncology of the Ministry of Health of the Nizhny Novgorod Region, Director, Nizhny Novgorod Regional Clinical Oncology Center 

ID (WOS): E-4857-2014

190, Rodionova st., Nizhny Novgorod, 603093


N. M. Kiselev
Nizhny Novgorod Regional Clinical Oncology Center
Russian Federation

Nikolay M. Kiselev, MD, PhD, Head of the 2nd Oncology Department of Abdominal Oncology and Endovascular Diagnostics and Treatment, Nizhny Novgorod Regional Clinical Oncology Center; Associate Professor, Department of General Surgery and Transplantology, Privolzhsky Research Medical University

190, Rodionova st., Nizhny Novgorod, 603093


V. N. Zaikovsky
Nizhny Novgorod Regional Clinical Oncology Center
Russian Federation

Vyacheslav N. Zaikovsky, MD Physician, 2nd Oncology Department of Abdominal Oncology and Endovascular Diagnostics and Treatment

ID (WOS): PMR-4020-2026

190, Rodionova st., Nizhny Novgorod, 603093


D. V. Erygin
Oncology Center NO. 1, S.S. Yudin City Clinical Hospital
Russian Federation

Dmitry V. Erygin, MD, DSc, Head of Oncology Department No. 1

Author ID (Scopus): 23472296700

bldg. 7, 18a, Zagorodnoye shosse, Moscow, 117152


V. K. Lyadov
Oncology Center NO. 1, S.S. Yudin City Clinical Hospital; Novokuznetsk State Institute for Further Training of Physicians - branch of the Russian Medical Academy of Continuing Professional Education; Russian Medical Academy of Continuing Professional Education
Russian Federation

Vladimir K. Lyadov, MD, DSc, Associate Professor, Head of Oncology Department No. 4, Oncology Center No. 1, S.S. Yudin City Clinical Hospital; Head of the Department of Oncology, Novokuznetsk State Institute for Further Training of Physicians; Professor, Department of Oncology and Palliative Medicine named after Academician A.I. Savitsky, Russian Medical Academy of Continuing Professional Education

Author ID (Scopus): 57218552793

bldg. 7, 18a, Zagorodnoye shosse, Moscow, 117152; 
5, Stroiteley Ave., Novokuznetsk, 654005; 
bldg. 1, 2/1, Barrikadnaya St., Moscow, 125993


I. A. Sklyar
Oncology Center NO. 1, S.S. Yudin City Clinical Hospital
Russian Federation

Ilya A. Sklyar, MD, Oncologist, Oncology Department No. 2

bldg. 7, 18a, Zagorodnoye shosse, Moscow, 117152


I. V. Kolobaev
P.A. Hertsen Moscow Oncology Research Institute - branch of the national Medical Research Center of Radiology
Russian Federation

Ilya V. Kolobaev, MD, PhD, Head of the Thoracoabdominal Department

3, 2nd Botkinsky Proezd, Moscow, 125284


V. M. Khomyakov
P.A. Hertsen Moscow Oncology Research Institute - branch of the national Medical Research Center of Radiology
Russian Federation

Vladimir M. Khomyakov, MD, DSc, Head of Thoracoabdominal Surgery Department

3, 2nd Botkinsky Proezd, Moscow, 125284


M. Yu. Valkov
Arkhangelsk Clinical Oncology Center; Northern State Medical University
Russian Federation

Mikhail Yu. Valkov, MD, DSc, Professor, Head of the Department of Radiation Diagnostics, Radiation Therapy and Oncology, Northern State Medical University; Radiotherapist, Arkhangelsk Clinical Oncology Center 

Author ID (Scopus): 6506508968.
Researcher ID (WOS): L-4441-2018.

bldg. 1, 145, Obvodny Kanal Ave., Arkhangelsk, 163045; 
51, Troitsky Ave., Arkhangelsk, 163000


P. A. Kurchatov
Arkhangelsk Clinical Oncology Center; Northern State Medical University
Russian Federation

Petr A. Kurchatov, PhD Student, Department of Radiology, Radiation Therapy and Oncology, Northern State Medical University; Head of the Operating Unit, Oncologist of the Department of Abdominal and Thoracic Oncology, Arkhangelsk Clinical Oncology Center

Author ID (Scopus): 60169947500.
Researcher ID (WOS): POV-3318-2026. 

bldg. 1, 145, Obvodny Kanal Ave., Arkhangelsk, 163045; 
51, Troitsky Ave., Arkhangelsk, 163000


A. M. Karachun
N.N. Petrov national Medical Research Center of Oncology
Russian Federation

Alexey M. Karachun, MD, DSc, Head of the Surgical Department of Abdominal Oncology 

Author ID (Scopus): 6505903635.
Researcher ID (WOS): AAC-4011-2019

68, Leningradskaya St., Pesochny, Saint Petersburg, 197758


P. A. Sapronov
N.N. Petrov national Medical Research Center of Oncology
Russian Federation

Pavel A. Sapronov, MD, Oncologist, Surgical Department of Abdominal Oncology

68, Leningradskaya St., Pesochny, Saint Petersburg, 197758


S. G. Afanasyev
Cancer Research Institute, Tomsk national Research Medical Center, Russian Academy of Sciences
Russian Federation

Sergey G. Afanasyev, MD, DSc, Professor, Head of the Department of Abdominal Oncology 

Author ID (Scopus): 7005336732.
Researcher ID (WOS): D-2084-2012. 

5, Kooperativny St., Tomsk, 634009


A. V. Avgustinovich
Cancer Research Institute, Tomsk national Research Medical Center, Russian Academy of Sciences
Russian Federation

Alexandra V. Avgustinovich, MD, PhD, Senior Researcher, Department of Abdominal Oncology

Researcher ID (WOS) D-6062-2012.
Author ID (Scopus) 56392965300. 

5, Kooperativny St., Tomsk, 634009


O. V. Cheremisina
Cancer Research Institute, Tomsk national Research Medical Center, Russian Academy of Sciences
Russian Federation

Olga V. Cheremisina, MD, DSc, Head of Endoscopy Department 

Researcher ID (WOS): С-9259-2012.
Author ID (Scopus): 6602197938.

5, Kooperativny St., Tomsk, 634009


I. G. Gataullin
Kazan State Medical Academy - branch of the Russian Medical Academy of Continuing Professional Education
Russian Federation

Ilgiz G. Gataullin, MD, DSc, Corresponding Member of the Academy of Sciences of the Republic of Tatarstan, Professor, Department of Oncology, Radiology and Palliative Medicine

Author ID (Scopus): 57021639200.
Researcher ID (WOS): B-1445-2019.

11, Mushtari St., Kazan, 420012


S. V. Osminin
I.M. Sechenov First Moscow State Medical University
Russian Federation

Sergey V. Osminin, MD, DSc, Head of the Surgical Department, University Clinical Hospital No. 1; Professor, Department of General Surgery No. 1, N.V. Sklifosovsky Institute of Clinical Medicine

bldg. 2, 8, Trubetskaya St., Moscow, 119048


M. N. Lando
Lipetsk Regional Oncology Dispensary
Russian Federation

Mikhail N. Lando, MD, PhD, Head of Surgical Department No. 6

1E, Admiral Makarov St., Lipetsk, 398005


T. A. Agababyan
A.F. Tsyb Medical Radiological Research Center - branch of the National Medical Research Center of Radiology
Russian Federation

Tatev A. Agababyan, MD, PhD, Head of the Department of Radiation Diagnostics

Researcher ID (WOS): F-2790-2014.
Author ID: 622660. 

4, Koroleva St., Obninsk, 249031


S. A. Ivanov
A.F. Tsyb Medical Radiological Research Center - branch of the National Medical Research Center of Radiology; RUDN University
Russian Federation

Sergey A. Ivanov, MD, DSc, Professor, Corresponding Member of the Russian Academy of Sciences, Director, A.F. Tsyb Medical Radiological Research Center; Professor, Department of Oncology and Roentgenoradiology named after V.P. Kharchenko, Medical Institute, RUDN University

4, Koroleva St., Obninsk, 249031;
6, Miklukho-Maklaya St., Moscow, 117198


A. D. Kaprin
P.A. Hertsen Moscow Oncology Research Institute - branch of the national Medical Research Center of Radiology; RUDN University; National Medical Research Center of Radiology
Russian Federation

Andrey D. Kaprin, MD, DSc, Professor, Full Member (Academician) of the Russian Academy of Sciences and the Russian Academy of Education, Head of the Department of Oncology and Roentgenoradiology named after V.P. Kharchenko, RUDN University; Director, P.A. Herzen Moscow Cancer Research Institute; Director General, National Medical Research Center of Radiology

3, 2nd Botkinsky Proezd, Moscow, 125284;
6, Miklukho-Maklaya St., Moscow, 117198; 
4, Koroleva St., Obninsk, 249036


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Supplementary files

1. Fig. 1. Abdominal CT before and after neoadjuvant chemotherapy: a – cancer of the cardiac region of the stomach; b – reduction in linear tumor dimensions, disappearance of tumor structure heterogeneity, and the appearance of a layered structure of the stomach wall (therapeutic pathomorphosis grade 1a). Note: created by the authors
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Skoropad V.Yu., Smolenov E.I., Grinevich V.N., Volobuev S.M., Gamayunov S.V., Kiselev N.M., Zaikovsky V.N., Erygin D.V., Lyadov V.K., Sklyar I.A., Kolobaev I.V., Khomyakov V.M., Valkov M.Yu., Kurchatov P.A., Karachun A.M., Sapronov P.A., Afanasyev S.G., Avgustinovich A.V., Cheremisina O.V., Gataullin I.G., Osminin S.V., Lando M.N., Agababyan T.A., Ivanov S.A., Kaprin A.D. Multicenter cohort retrospective clinical study assessing the impact of complete pathological tumor response on survival rates in patients with locally advanced gastric and esophagogastric junction cancer: demographic and clinical-morphological characteristics, treatment options and immediate results (report 2). Siberian journal of oncology. 2026;25(3):5-20. (In Russ.) https://doi.org/10.21294/1814-4861-2026-25-3-5-20

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ISSN 1814-4861 (Print)
ISSN 2312-3168 (Online)

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