ArticleFrontiers in immunology2026
Optimizing patient selection for neoadjuvant immunotherapy in gastric cancer via pre-treatment imaging analysis.
Article in Frontiers in immunology, 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
Background: The clinical efficacy of neoadjuvant immunotherapy combined with chemotherapy (NICT) in patients with locally advanced gastric cancer (LAGC) exhibits considerable variability. In this study, we developed and validated a radiomics-based scoring system to inform personalized neoadjuvant therapy strategies. Methods: A retrospective analysis was conducted on a multicenter cohort comprising 633 LAGC patients who underwent neoadjuvant therapy between 2019 and 2023. The primary endpoint was major pathological response (MPR). Radiomic features were extracted and selected from contrast-enhanced CT images obtained before neoadjuvant therapy to construct a radiomics scoring system, which stratified patients into high-, intermediate-, and low-score groups. The therapeutic outcomes across different groups were compared to discern patients who are likely to benefit from NICT as opposed to those who would derive more benefit from neoadjuvant chemotherapy alone (NACT). Additionally, analysis of tumor microenvironment immune infiltration and functional enrichment were performed to explore the potential biological mechanisms underlying the radiomic signatures. Results: In the intermediate-score group, the MPR rates were significantly higher among patients receiving NICT compared to those receiving NACT (training set: 49.2% vs. 26.0%, Conclusion: The radiomics scoring system exhibits potential for stratifying patients who may be appropriate candidates for NICT or for whom the de-escalation of immunotherapy might be considered in future prospective studies, thereby contributing to the optimization of neoadjuvant treatment strategies.
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