{ "abstract": "Background: Perioperative chemotherapy remains the standard-of-care for resectable gastric and gastroesophageal junction (G/GEJ) adenocarcinoma, yet pathologic complete response (pCR) rates remain low and long-term survival is suboptimal. Apatinib has shown efficacy in advanced G/GEJ cancer, but its role and optimal combination regimens in the neoadjuvant setting remain unclear, and no quantitative evidence synthesis has been published. This systematic review and single-arm meta-analysis aimed to evaluate the efficacy and safety of neoadjuvant apatinib-based regimens for resectable G/GEJ adenocarcinoma.\n\nMethods: A systematic literature search was conducted across PubMed, Embase, the Cochrane Library, Web of Science, and major oncology conference proceedings up to January 1, 2026. Single-arm studies reporting neoadjuvant apatinib-based therapy for resectable G/GEJ adenocarcinoma were included. Primary outcomes were pCR rate, major pathologic response (MPR) rate, R0 resection rate, objective response rate (ORR), and disease control rate (DCR); secondary outcomes were grade ≥3 treatment-related adverse events (TRAEs) and postoperative complications. Pooled proportions with 95% confidence intervals were calculated using logit-transformed single-arm meta-analysis; random- or fixed-effects models were selected based on between-study heterogeneity (I²). Analyses were performed in R, Review Manager 5.4, and Stata 17.0.\n\nResults: Twenty studies enrolling 1026 patients with resectable G/GEJ cancer were initially included. After excluding one potentially overlapping cohort (Jianxian Lin 2024, n=51), 19 studies with 975 patients were included in the primary analysis. The pooled pCR rate of neoadjuvant apatinib-based therapy was 21% (95% CI: 18%–25%, I² = 19.4%), and the pooled major pathologic response (MPR) rate was 39% (95% CI: 34%–45%, I² = 37.8%). The R0 resection rate reached 93% (95% CI: 90%–95%, I² = 37.6%), with an objective response rate (ORR) of 70% (95% CI: 66%–74%, I² = 24.4%) and a disease control rate (DCR) of 95% (95% CI: 92%–96%, I² = 0%). The overall incidence of grade ≥3 treatment-related adverse events (TRAEs) was 31% (95% CI: 21%–43%, I² = 80.1%), and the pooled rate of postoperative complications was 27% (95% CI: 22%–32%, I² = 44.6%). In exploratory subgroup analysis, pCR rates were 12% in the nACT group and 22% in the nAICT group, with similar directional differences observed in MPR, ORR, and R0 resection; however, these were indirect, non-randomized comparisons and are presented descriptively as hypothesis-generating.\n\nConclusion: This meta-analysis reports that neoadjuvant apatinib-containing regimens are associated with a pooled pCR rate of 21%, MPR rate of 39%, R0 resection rate of 93%, and DCR of 95%. These descriptive estimates suggest that apatinib-containing neoadjuvant therapy is feasible in selected patients and warrants further investigation in randomized controlled trials. However, because the evidence is predominantly non-comparative and heterogeneous, no conclusion regarding comparative efficacy or safety superiority over conventional therapy can be drawn.\n\nSystematic review registration: https://www.crd.york.ac.uk/prospero/ , identifier CRD42023478481.", "abstract_shown": true, "affiliations": [ "Department of Thoracic Surgery, The Second Hospital of Jilin University", "Department of Gastrointestinal Medicine, The First Hospital of Jilin University" ], "article_type": "systematic review", "arxiv": null, "author_total": 7, "authors": [ { "affs": [ 0 ], "name": "Kaiyi Xin" }, { "affs": [ 1 ], "name": "Zhilu Chen" }, { "affs": [ 1 ], "name": "Liu Yang" }, { "affs": [ 0 ], "name": "Li Qin" }, { "affs": [ 0 ], "name": "Shu Chen" }, { "affs": [ 0 ], "name": "Tianjiao Xiao" }, { "affs": [ 0 ], "name": "Yinghao Zhao" } ], "bibtex": "https://research.draconitic.com/paper/c7yesyetbvb25.bib", "cited_by": 0, "doi": "10.3389/fonc.2026.1910490", "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13724539/?tool=EBI", "id": "c7yesyetbvb25", "issns": [ "2234-943X" ], "landing_url": "https://www.frontiersin.org/articles/10.3389/fonc.2026.1910490/full", "language": "eng", "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "Systematic Review" ], [ "openalex", "2740|Gastric Cancer Management and Outcomes" ] ], "openalex": "W7222945248", "pdf_url": "https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2026.1910490/pdf", "pmcid": "PMC13724539", "pmid": "42973835", "published": "2026-10-19", "publisher": "Frontiers Media SA", "ris": "https://research.draconitic.com/paper/c7yesyetbvb25.ris", "sources": [ { "first_seen": "2026-10-30T12:20:13Z", "native_id": "10.3389/fonc.2026.1910490", "source": "crossref", "url": "https://www.frontiersin.org/articles/10.3389/fonc.2026.1910490/full" }, { "first_seen": "2026-11-03T15:20:50Z", "native_id": "PMC:PMC13724539", "source": "europepmc", "url": "https://europepmc.org/article/PMC/PMC13724539" }, { "first_seen": "2026-11-04T12:23:05Z", "native_id": "PMC13724539", "source": "pmc", "url": "https://doi.org/10.3389/fonc.2026.1910490" }, { "first_seen": "2026-11-04T15:20:48Z", "native_id": "MED:42973835", "source": "europepmc", "url": "https://europepmc.org/article/MED/42973835" } ], "subjects": [ { "field": "medicine", "origin": "issn:2234-943X", "subfield": "oncology" } ], "title": "Efficacy and safety of apatinib-containing neoadjuvant regimens for resectable gastric and gastroesophageal junction adenocarcinoma: a systematic review and single-arm meta-analysis", "title_text": "Efficacy and safety of apatinib-containing neoadjuvant regimens for resectable gastric and gastroesophageal junction adenocarcinoma: a systematic review and single-arm meta-analysis", "type": "peer-reviewed", "updated_at": "2026-11-05T12:21:16Z", "url": "https://research.draconitic.com/paper/c7yesyetbvb25", "venue": "Frontiers in Oncology", "versions": [] }