From March 12 to 14, 2025, the 97th Annual Meeting of the Japanese Gastric Cancer Association (JGCA 2025) was held at the Nagoya Congress Center, bringing together leading experts from Japan and across the globe to exchange insights on the latest advancements in gastric cancer prevention and treatment. The event also spotlighted the application and future potential of digital innovations in the field.
Among the institutions contributing prominently to this year’s meeting was the General Hospital of the People’s Liberation Army (PLAGH), which had multiple research projects accepted for oral presentation. These studies focused on predicting treatment efficacy and optimizing strategies for neoadjuvant therapy in locally advanced gastric cancer. To offer further insight, we invited Professor Bo Wei, the corresponding author of these studies from The First Medical Center of Chinese PLA General Hospital, to provide an exclusive expert commentary.
I.
Since the landmark MAGIC trial, neoadjuvant therapy—primarily involving chemotherapy and immunotherapy—has become increasingly adopted in the management of locally advanced gastric cancer (LAGC). In recent years, studies such as RESOLVE and RESONANCE have further confirmed that neoadjuvant therapy followed by radical gastrectomy significantly improves R0 resection rates and overall treatment completion, translating into better long-term survival for patients.
Pathological complete response (pCR) has emerged as a key pathological indicator for assessing short-term treatment efficacy after neoadjuvant therapy. Its value lies not only in evaluating treatment sensitivity but also in informing personalized treatment decisions, such as identifying patients suitable for function-preserving surgery. As such, accurately predicting which patients will achieve pCR is of critical clinical importance.
While numerous studies have explored predictive models for pCR using multi-omics approaches, liquid biopsy, and traditional clinicopathological variables—with varying levels of accuracy—there remains limited evidence supporting the use of gastric tumor biomarkers alone to develop high-performance nomogram models for pCR prediction.
This study focuses specifically on gastric-specific tumor biomarkers. Through logistic regression analysis, the researchers identified four independent predictors of pCR in LAGC patients undergoing neoadjuvant therapy:
- receiving neoadjuvant immunotherapy,
- CA72-4 < 2.5 U/mL,
- gastrin-17 < 1.48 pmol/L, and
- tumor bed diameter < 2.85 cm.
Based on these variables, the team developed a nomogram prediction model, which demonstrated strong predictive performance with an AUC (95% CI) of 0.863 (0.785–0.942). Compared to traditional categorical analysis, this model offers superior predictive value, providing a valuable clinical tool for determining surgical timing and estimating the degree of tumor regression.
Although the study was limited by its sample size and lacked a separate training and validation cohort, thus requiring further validation through large-scale clinical trials, it nonetheless underscores the clinical utility of monitoring gastric tumor biomarkers. These biomarkers may guide the identification of patients most likely to benefit from neoadjuvant therapy.
Looking forward, further research is warranted to explore dynamic changes in tumor biomarkers during treatment, their correlation with long-term survival in pCR patients, and the underlying mechanisms by which these markers influence treatment response. A systematic understanding of these aspects could significantly enhance the predictive and practical value of tumor biomarkers in the personalized management of gastric cancer.
II.
In 2025, the RESOLVE trial—a multicenter phase III clinical study led by Peking University Cancer Hospital—released updated results in The Lancet Oncology. The findings demonstrated that perioperative treatment with SOX significantly improved both 5-year overall survival (60.0% vs. 52.1%, P=0.049) and disease-free survival (53.2% vs. 45.8%, P=0.034) compared to adjuvant CAPOX, firmly establishing SOX as a cornerstone in the neoadjuvant management of locally advanced gastric cancer (LAGC).
In the era of immunotherapy, several phase II trials—such as the PERSIST study led by Professor Han Liang of Tianjin Medical University Cancer Institute and Hospital—have shown that combining SOX with immune checkpoint inhibitors (ICIs) leads to significantly higher pathological complete response (pCR) rates than SOX chemotherapy alone. This multicenter retrospective study echoes those findings: patients receiving SOX+ICIs achieved higher objective response rates (ORR), major pathological response rates (MPR), and pCR rates than those receiving chemotherapy alone, reaffirming the enhanced tumor regression potential of this combined approach. However, due to limited follow-up, the study did not assess the correlation between tumor regression and long-term survival.
As neoadjuvant therapy continues to improve tumor response and oncologic outcomes, perioperative safety has become a growing concern for surgeons. Preoperative treatment may obscure anatomical planes around the stomach, increase tissue fibrosis and fragility, and lead to exudative edema. Additionally, adverse effects such as myelosuppression, immune-related hypothyroidism, and immune-mediated diarrhea can compromise patients’ immune status and overall condition—posing further challenges in perioperative management.
Laparoscopic gastrectomy, a hallmark of minimally invasive surgery, is widely applied in the treatment of gastric cancer. This study focused on evaluating the safety of laparoscopic gastrectomy following neoadjuvant SOX+ICIs compared to SOX alone. The findings revealed that intraoperative blood loss was significantly lower in the SOX+ICIs group (P=0.001). Importantly, there was no significant difference in overall or severe complication rates between the two groups (25.0% vs. 18.9%, P=0.198; 5.0% vs. 5.3%, P=0.898), confirming the feasibility and safety of laparoscopic gastrectomy following SOX+ICIs.
Further multivariate analysis identified that patients with high intraoperative blood loss and a Prognostic Nutritional Index (PNI) <40 after neoadjuvant therapy may require special attention during the perioperative period. For these patients, developing individualized management strategies could help minimize postoperative complications.
In conclusion, the rapid development of minimally invasive gastric cancer surgery is not only accelerating recovery and improving quality of life, but also expanding surgical indications. This study provides multicenter evidence supporting the safety of laparoscopic radical gastrectomy following neoadjuvant SOX+ICIs in LAGC patients. Future research should focus on long-term survival, conversion therapy, and innovations in intelligent and remote minimally invasive surgery, to fully assess the integrated benefits of combining perioperative systemic therapy with surgical intervention.
Corresponding Author
- Deputy Director, Department of General Surgery, First Medical Center, PLAGH
- Chief Physician, Professor, Doctoral Supervisor
- Recognized as a Leading Talent in Military Scientific Innovation and recipient of the prestigious “Outstanding Young Talent” award
- Recipient of the State Council Special Allowance
- Chair of the Digestive Tract Tumor Committee, Chinese Research Hospital Association
- Standing Member and Secretary-General of the Upper GI Surgery Committee, Chinese Medical Doctor Association
- Principal investigator of more than ten national and municipal-level research projects, including grants from the National Natural Science Foundation of China, the National Key R&D Program, and Beijing Science and Technology initiatives
- Lead contributor to award-winning research projects in the field of minimally invasive gastrointestinal oncology and perioperative management, having received the First Prize of the Chinese Medical Science and Technology Award and the Hainan Provincial Science and Technology Progress First Prize
- Author of over 100 academic publications as corresponding author in high-impact journals, including Gastroenterology, Signal Transduction and Targeted Therapy, Advanced Materials, iMeta, Military Medical Research, and the International Journal of Surgery
First Author
Dr. Hao Cui
- Joint PhD candidate jointly trained by Nankai University and the General Hospital of the People’s Liberation Army (PLAGH)
- Research focus: Minimally invasive surgical treatment of gastric cancer and prediction of treatment response during the perioperative period
- First or co-first author of 12 SCI-indexed publications and 13 papers in core Chinese medical journals
- Delivered oral presentations as first author at numerous major academic conferences, including the International Gastric Cancer Congress, Japanese Gastric Cancer Association Annual Meeting, Korea International Gastric Cancer Week, and the National Gastric Cancer Congress
- Recipient of multiple prestigious awards, including the First Prize of the Chinese Medical Science and Technology Award, First Prize of the Hainan Provincial Science and Technology Progress Award, Best Oral Presentation Award at the National Gastric Cancer Conference, Second Prize in the National Youth General Surgery English Paper Competition, the Zhou Enlai Scholarship from Nankai University, and recognition as one of Nankai University’s “Students of the Year”
