The Impact of Neoadjuvant Chemoradiotherapy on Tumor Downstaging in Locally Advanced Gastric Cardia Cancer

Introduction: Neoadjuvant chemoradiotherapy (nCRT) has emerged as a promising approach for improving surgical and oncologic outcomes in locally advanced gastric cardia cancer (LAGCC). This study aims to evaluate the impact of nCRT on tumor downstaging, resection rates, and postoperative complications compared to surgery alone.Materials and Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Studies comparing nCRT followed by surgery versus surgery alone in patients with LAGCC (cT۳–T۴ and/or N+) were included. Key outcomes analyzed included tumor and nodal downstaging rates, R۰ resection rates, operative time, postoperative complications, and length of hospital stay. Statistical heterogeneity was assessed using the I² statistic, and pooled estimates were calculated using appropriate models.Results: Patients receiving nCRT demonstrated significantly higher tumor downstaging rates (۶۳.۴۶% vs. ۳۰.۸۷%, p<۰.۰۰۱) and nodal downstaging rates (۳۹.۷۴% vs. ۱۸.۴۶%, p<۰.۰۰۱). R۰ resection was more frequent in the nCRT group (۸۹.۴۲% vs. ۸۰.۸۷%, p=۰.۰۰۴). Postoperative complications, including severe complications and anastomotic leakage, were comparable between groups. However, nCRT was associated with a longer operative time (۲۱۴.۸۳ vs. ۱۹۶.۴۲ min, p=۰.۰۳۱) and hospital stay (۱۳.۵۲ vs. ۱۲.۱۱ days, p=۰.۰۲۹).Conclusion: nCRT significantly improves tumor downstaging and R۰ resection rates without increasing severe postoperative complications. These findings support its role as a standard treatment in LAGCC.

کلیدواژه ها:

Neoadjuvant chemoradiotherapy ، gastric cardia cancer ، tumor downstaging ، R۰ resection