Background: Neoadjuvant chemotherapy (NAC) has been defined as any preoperative chemotherapy
scheme aiming to reduce tumor staging and to control preoperative micrometastasis, which has been extensively
used as a treatment for resectable gastric cancer. However, its effect on the long-term survival of patients with
locally advanced gastric cancer (AGC) or esophagogastric junction cancer (EGC) remains unknown.
Objective: This study aimed at investigating the long-term efficacy of NAC in locally AGC/EGC.
Methods: The following databases were searched for articles published from their inception to April 2020:
PubMed, Web of Science, EBSCO, and Cochrane library. The primary outcomes were overall survival (OS) and
progression-free survival (PFS).
Results: A total of 19 articles were included in this meta-analysis, with a total of 4,446 patients. The results
showed that NAC increased the patients’ 3-year OS (HR: 0.56, 95% CI, 0.21 - 0.91, p < 0.001), 3-year PFS (HR:
0.76, 95% CI, 0.66 - 0.87, p < 0.001), 5-year OS (HR: 0.71, 95% CI, 0.64 - 0.78, p < 0.001), and 5-year PFS
(HR: 0.70, 95% CI, 0.61 - 0.79, p < 0.001). Besides, subgroup analysis showed that Asian countries have
benefited significantly from NAC (HR: 0.65, 95% CI, 0.55 - 0.74, p < 0.001), and other countries have also
benefited (HR: 0.79, 95% CI, 0.68 - 0.89, p < 0.001).
Conclusion: Compared with adjuvant chemotherapy and surgery alone, NAC can improve the long-term survival
outcomes (OS and PFS) of patients with resectable AGC or EGC.