ArticleClinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico2026
Prognostic ımpact of the modified Ryan tumor regression score in gastric and GEJ adenocarcinomas treated with neoadjuvant FLOT regimen.
Article in Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveThis study aimed to evaluate the prognostic significance of the Modified Ryan Tumor Regression Score (TRG) in predicting overall survival (OS) and disease-free survival (DFS) among patients with locally advanced gastric and gastroesophageal junction (GEJ) adenocarcinomas treated with neoadjuvant FLOT chemotherapy (5-fluorouracil, leucovorin, oxaliplatin, and docetaxel). We aimed to evaluate whether the modified Ryan TRG independently predicts DFS and OS in a homogeneous FLOT-treated cohort. MATERIALS AND
methodsPatients with locally advanced gastric or GEJ adenocarcinomas who received neoadjuvant FLOT and underwent curative surgery were retrospectively reviewed. The Modified Ryan TRG was categorized into four grades (0-3) according to the proportion of residual viable tumor cells.
resultsA total of 154 patients were included in the analysis. Among all patients, 26.6% achieved a good pathological response (TRG 0-1), 24.7% had a partial response (TRG 2), and 48.7% showed minimal or no response (TRG 3). Median DFS and OS were not reached in the TRG 0-1 group, whereas they were 16.1 and 29.9 months, respectively, in the TRG 3 group (p < 0.001). Lower TRG (0-1) independently predicted improved DFS (HR = 0.07, p < 0.001) and OS (HR = 0.10, p = 0.002).
conclusionThe Modified Ryan Tumor Regression Score represents a strong and independent prognostic indicator in patients with locally advanced gastric and GEJ adenocarcinomas treated with the FLOT regimen. Patients with low TRG (0-1) scores exhibit superior survival outcomes, while those with high TRG (3) scores may benefit from closer follow-up and intensified adjuvant strategies. Prospective studies are warranted to validate TRG-based individualized treatment approaches.
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