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This real-world study aimed to evaluate the efficacy and safety of neoadjuvant immunochemotherapy in patients with locally advanced gastric cancer (LAGC).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Patients with LAGC (cT2-4bN1-3M0) were enrolled in this retrospective study. Patients received either neoadjuvant immunochemotherapy or chemotherapy alone before surgery. The primary endpoint was the pathological complete response (pCR) rate.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>A total of 111 patients were included in this study, with 49 received neoadjuvant PD-1 inhibitors combined with chemotherapy (Group A) and 62 received chemotherapy alone (Group B). pCR rate of Group A was significantly higher than that of Group B (22.4% vs. 4.8%, <jats:italic>P<\/jats:italic>\u2009=\u20090.011). Compared with the clinical TNM stage before neoadjuvant therapy, 32 (65.3%) patients in Group A had T downstaging, 27 (55.1%) had N downstaging, and 42 (85.7%) had overall TNM downstaging. There was no significant difference in 1-year OS rate (100% vs. 93.5%; <jats:italic>P<\/jats:italic>\u2009=\u20090.195) and 1-year DFS rate (81.6% vs. 75.8%; <jats:italic>P<\/jats:italic>\u2009=\u20090.144) between the two groups. 11.7% patients in Group A and 9.8% patients in Group B experienced grade\u2009\u2265\u20093 adverse TRAEs, myelosuppression, elevated ALT\/AST, nausea, and decreased appetite. However, there was no significant difference between the two groups (<jats:italic>P<\/jats:italic>\u2009=\u20090.240).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Here, neoadjuvant immunochemotherapy suggested a potential clinical benefit of the pCR rate, T downstaging, and a favorable safety profile for LAGC. However, further multicenter, large-scale randomized clinical trials are urgently needed to confirm the long-term survival benefit.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00262-025-04153-6","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T07:12:40Z","timestamp":1758179560000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["The efficacy and safety of neoadjuvant immunotherapy combined with chemotherapy for locally advanced gastric cancer: a single-center, real-world clinical study"],"prefix":"10.1007","volume":"74","author":[{"given":"Xuan","family":"Pan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huayun","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingwang","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siwen","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuchen","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Yue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pingping","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,18]]},"reference":[{"key":"4153_CR1","first-page":"17","volume":"73","author":"RL Siegel","year":"2023","unstructured":"Siegel RL, Miller KD, Wagle NS et al (2023) Cancer statistics, 2023. 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