Tumor Regression After Neoadjuvant Therapy- Does TRG Really Predict Survival? ESMO GI Oncology | 2026

What Did the Study Find?

This 19-year real-world study evaluated 692 patients with locally advanced, resectable gastroesophageal adenocarcinoma, including 394 who received neoadjuvant systemic therapy.

Most patients showed poor pathological response despite neoadjuvant treatment.

Better tumor regression grades (TRG) correlated with lower ypT/ypN stage and less lymphatic, venous, and perineural invasion.

Mandard TRG predicted both disease-free and overall survival, whereas Becker TRG did not.

However, conventional pathological factors—including ypT, ypN, resection status and invasive features—remained the strongest prognostic determinants.

TRG also varied according to the neoadjuvant treatment strategy used.

Why Does It Matter?

TRG provides useful information about treatment response, but its prognostic value appears closely linked to established postoperative pathological staging.

GastroAGI Takeaway

Mandard TRG may add prognostic information after neoadjuvant therapy, but it should complement—not replace—ypTNM and conventional pathological risk assessment. Current evidence does not support using TRG alone to guide adjuvant treatment decisions.