Neoadjuvant Therapy for Gastric Adenocarcinoma with Signet Ring Cells: A Systematic Review and Meta-Analysis.

In 30 seconds

This systematic review and random-effects meta-analysis assessed neoadjuvant chemotherapy followed by surgery versus upfront gastrectomy in adults with signet ring cell-containing gastric cancer. Six studies comprising seven cohorts and 5.388 patients contributed overall-survival data. Neoadjuvant chemotherapy was not associated with a significant overall-survival difference compared with upfront surgery (HR 0.96, 95% CI 0.68-1.34, I 2 = 83.2%). Subgroup analyses by geographic region and study design likewise found no significant differences. The authors note that further studies using contemporary chemotherapy regimens are needed to clarify the role of neoadjuvant treatment in this histological subtype.

Key findings

• Across six studies and seven cohorts, pooled overall survival did not differ significantly between strategies (HR 0.96, 95% CI 0.68-1.34, I 2 = 83.2%).
• Western studies showed no significant survival difference (HR 0.85, 95% CI 0.53-1.38, I² = 86.9%); Eastern studies were also nonsignificant (HR 1.12, 95% CI 0.63-1.97, I² = 83%).
• Results were nonsignificant in randomized trials (HR 1.16, 95% CI 0.81-1.67) and observational studies (HR 0.92, 95% CI 0.62-1.38, I² = 85.5%).

Why it matters

Signet ring cell-containing gastric cancer may not share the same observed survival response to neoadjuvant chemotherapy as broader locally advanced gastric cancer populations. This synthesis finds no significant overall-survival advantage over upfront surgery in the included evidence, highlighting uncertainty when applying general perioperative-treatment evidence to this subtype.

What to keep in mind

The pooled estimate had substantial heterogeneity (I 2 = 83.2%), and the evidence comprised only six studies. The abstract does not establish whether the included chemotherapy regimens reflect contemporary practice.