{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T06:30:53Z","timestamp":1786516253123,"version":"build-2736575974"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Research on the efficacy of perioperative immunotherapy for gastric cancer with para-aortic lymph node (PAN) metastasis remains limited. This study aimed to compare the safety and efficacy of chemotherapy plus programmed cell death protein-1 (PD-1) inhibitor versus chemotherapy alone in locally advanced GC patients with PAN metastasis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed patients with gastric cancer and limited No.16a2\/b1 lymph node metastasis who received perioperative systemic therapy combined with D2 gastrectomy plus PAN dissection (PAND) between January 2018 and February 2024. Patients were divided into Group A (chemotherapy+PD-1 inhibitor, n=62) and Group B (chemotherapy alone, n=71). Pathological response, survival outcomes, and safety were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All patients in Group A achieved R0 resection, compared with 98.6% in Group B. Pathological outcomes were significantly better in Group A, with higher rates of pathological complete response (pCR; 37.1% vs. 4.2%, P&amp;lt;0.001) and major pathological response (MPR; 58.1% vs. 22.5%, P&amp;lt;0.001) compared to Group B. In Group A, patients with programmed death ligand-1 (PD-L1) combined positive score (CPS) \u22655 had higher pCR rates. The 3-year overall survival (OS) rate was also higher in Group A (64.5% vs. 42.3%). The median OS for Group B was 33.2 months, while Group A was not reached (P\u00a0=\u00a00.023). Adverse event incidences were comparable between groups, with no treatment-related deaths.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Perioperative immunochemotherapy significantly enhances pathological response and survival in GC patients with PAN metastasis, with manageable safety. This regimen represents a promising therapeutic strategy for this patient population, necessitating long-term follow-up to confirm durable benefits.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1835041","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T05:56:02Z","timestamp":1786514162000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Perioperative PD-1 inhibitor plus chemotherapy versus chemotherapy alone in gastric cancer with PAN metastasis undergoing D2 gastrectomy and PAND: a single-center retrospective cohort study"],"prefix":"10.3389","volume":"17","author":[{"given":"Zeyao","family":"Ye","sequence":"first","affiliation":[{"name":"Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weixing","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences","place":["Hangzhou, Zhejiang, China"]},{"name":"Postgraduate Training Base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital)","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengfei","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangliu","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tengjiao","family":"Chai","sequence":"additional","affiliation":[{"name":"Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yian","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: Globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(20)31288-5","article-title":"Gastric cancer","volume":"396","author":"Smyth","year":"2020","journal-title":"Lancet"},{"key":"B3","doi-asserted-by":"publisher","first-page":"193","DOI":"10.21147\/j.issn.1000-9604.2021.02.07","article-title":"Current status of lymph node dissection in gastric cancer","volume":"33","author":"Ke","year":"2021","journal-title":"Chin J Cancer Res"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.issn.0366-6999.20130664","article-title":"Evaluation of para-aortic nodal dissection for locoregionally advanced gastric cancer with 1-3 involved para-aortic nodes","volume":"127","author":"Zhang","year":"2014","journal-title":"Chin Med J (Engl)"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21657","article-title":"Current treatment and recent progress in gastric cancer","volume":"71","author":"Joshi","year":"2021","journal-title":"CA Cancer J Clin"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/s1470-2045(21)00297-7","article-title":"Perioperative or postoperative adjuvant oxaliplatin with S-1 versus adjuvant oxaliplatin with capecitabine in patients with locally advanced gastric or gastro-oesophageal junction adenocarcinoma undergoing D2 gastrectomy (Resolve): An open-label, superiority and non-inferiority, phase 3 randomised controlled trial","volume":"22","author":"Zhang","year":"2021","journal-title":"Lancet Oncol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1007\/s00280-014-2449-1","article-title":"A phase II trial of Xeloda and oxaliplatin (XELOX) neo-adjuvant chemotherapy followed by surgery for advanced gastric cancer patients with para-aortic lymph node metastasis","volume":"73","author":"Wang","year":"2014","journal-title":"Cancer Chemother Pharmacol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s10120-022-01331-8","article-title":"Japanese Gastric Cancer Treatment Guidelines 2021 (6th edition)","volume":"26","year":"2023","journal-title":"Gastric Cancer"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdy540","article-title":"Safety and efficacy of nivolumab in combination with S-1\/capecitabine plus oxaliplatin in patients with previously untreated, unresectable, advanced, or recurrent gastric\/gastroesophageal junction cancer: Interim results of a randomized, phase II trial (Attraction-4)","volume":"30","author":"Boku","year":"2019","journal-title":"Ann Oncol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/S0140-6736(21)00797-2","article-title":"First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (Checkmate 649): A randomised, open-label, phase 3 trial","volume":"398","author":"Janjigian","year":"2021","journal-title":"Lancet"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-pathol-042020-042741","article-title":"Immune checkpoint inhibitors for the treatment of cancer: Clinical impact and mechanisms of response and resistance","volume":"16","author":"Bagchi","year":"2021","journal-title":"Annu Rev Pathol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1136\/jitc-2021-003635","article-title":"Efficacy and safety of neoadjuvant sintilimab, oxaliplatin and capecitabine in patients with locally advanced, resectable gastric or gastroesophageal junction adenocarcinoma: Early results of a phase 2 study","volume":"10","author":"Jiang","year":"2022","journal-title":"J Immunother Cancer"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1080\/2162402x.2022.2135819","article-title":"Neoadjuvant PD-1 blockade plus chemotherapy induces a high pathological complete response rate and anti-tumor immune subsets in clinical stage III gastric cancer","volume":"11","author":"Tang","year":"2022","journal-title":"Oncoimmunology"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1007\/s10120-023-01431-z","article-title":"SOX combined with sintilimab versus SOX alone in the perioperative management of locally advanced gastric cancer: A propensity score-matched analysis","volume":"26","author":"Huang","year":"2023","journal-title":"Gastric Cancer"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1097\/js9.0000000000002056","article-title":"The safety and efficacy of neoadjuvant PD-1 inhibitor plus chemotherapy for patients with locally advanced gastric cancer: A systematic review and meta-analysis","volume":"111","author":"Yu","year":"2024","journal-title":"Int J Surg"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1007\/s10120-022-01286-w","article-title":"A multicenter, open-label, single-arm phase I trial of neoadjuvant nivolumab monotherapy for resectable gastric cancer","volume":"25","author":"Hasegawa","year":"2022","journal-title":"Gastric Cancer"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2016.01.002","article-title":"The clinical significance of para-aortic nodal dissection for advanced gastric cancer","volume":"42","author":"Morita","year":"2016","journal-title":"Eur J Surg Oncol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"397","DOI":"10.21147\/j.issn.1000-9604.2016.04.02","article-title":"Evaluation of rational extent lymphadenectomy for local advanced gastric cancer","volume":"28","author":"Liang","year":"2016","journal-title":"Chin J Cancer Res"},{"key":"B19","article-title":"Significance of para-aortic lymph node dissection in advanced gastric cancer","volume":"46","author":"Kunisaki","year":"1999","journal-title":"Hepatogastroenterology"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s10120-020-01042-y","article-title":"Japanese Gastric Cancer Treatment Guidelines 2018 (5th Edition)","volume":"24","year":"2021","journal-title":"Gastric Cancer"},{"key":"B21","unstructured":"Common Terminology Criteria for Adverse Events Version 3.0 (Ctcae V.3.0)\n          \n          2006"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann Surg"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2008.10.026","article-title":"New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1)","volume":"45","author":"Eisenhauer","year":"2009","journal-title":"Eur J Cancer"},{"key":"B24","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1002\/ssu.2980100105","article-title":"Residual tumor (R) classification and prognosis","volume":"10","author":"Hermanek","year":"1994","journal-title":"Semin Surg Oncol"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.11660","article-title":"Histomorphology and grading of regression in gastric carcinoma treated with neoadjuvant chemotherapy","volume":"98","author":"Becker","year":"2003","journal-title":"Cancer"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0707035","article-title":"D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer","volume":"359","author":"Sasako","year":"2008","journal-title":"N Engl J Med"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1007\/s00280-010-1296-y","article-title":"Clinical characteristics and treatment outcomes of gastric cancer patients with isolated para-aortic lymph node involvement","volume":"67","author":"Park","year":"2011","journal-title":"Cancer Chemother Pharmacol"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1007\/s10120-016-0619-z","article-title":"A phase II study of preoperative chemotherapy with docetaxel, cisplatin, and S-1 followed by gastrectomy with D2 plus para-aortic lymph node dissection for gastric cancer with extensive lymph node metastasis: JCOG1002","volume":"20","author":"Ito","year":"2017","journal-title":"Gastric Cancer"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1002\/ctm2.1674","article-title":"Comprehensive multi-omics analysis of resectable locally advanced gastric cancer: Assessing response to neoadjuvant camrelizumab and chemotherapy in a single-center, open-label, single-arm phase II trial","volume":"14","author":"Zhao","year":"2024","journal-title":"Clin Transl Med"},{"key":"B30","doi-asserted-by":"publisher","first-page":"984","DOI":"10.1158\/2159-8290.Cd-21-0888","article-title":"Early tumor-immune microenvironmental remodeling and response to first-line fluoropyrimidine and platinum chemotherapy in advanced gastric cancer","volume":"12","author":"Kim","year":"2022","journal-title":"Cancer Discov"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/s1470-2045(23)00541-7","article-title":"Neoadjuvant and adjuvant pembrolizumab plus chemotherapy in locally advanced gastric or gastro-oesophageal cancer (KEYNOTE-585): An interim analysis of the multicentre, double-blind, randomised phase 3 study","volume":"25","author":"Shitara","year":"2024","journal-title":"Lancet Oncol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/j.esmoop.2024.103967","article-title":"PD-L1 thresholds predict efficacy of immune checkpoint inhibition in first-line treatment of advanced gastroesophageal adenocarcinoma. A systematic review and meta-analysis of seven phase III randomized trials","volume":"9","author":"Formica","year":"2024","journal-title":"ESMO Open"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.28463","article-title":"First-line sugemalimab plus chemotherapy for advanced gastric cancer: The GEMSTONE-303 randomized clinical trial","volume":"333","author":"Zhang","year":"2025","journal-title":"JAMA"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-025-03594-8","article-title":"Impact of pathological complete response on survival in gastric cancer after neoadjuvant chemotherapy: A propensity score matching analysis","volume":"25","author":"Chen","year":"2025","journal-title":"BMC Gastroenterol"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.9484","article-title":"Neoadjuvant chemotherapy with S-1 and cisplatin followed by D2 gastrectomy with para-aortic lymph node dissection for gastric cancer with extensive lymph node metastasis","volume":"101","author":"Tsuburaya","year":"2014","journal-title":"Br J Surg"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1193614","article-title":"Evaluation of neoadjuvant immunotherapy plus chemotherapy in Chinese surgically resectable gastric cancer: A pilot study by meta-analysis","volume":"14","author":"Xu","year":"2023","journal-title":"Front Immunol"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1007\/s00432-022-04302-9","article-title":"Neoadjuvant PD-1 inhibitor and apatinib combined with S-1 plus oxaliplatin for locally advanced gastric cancer patients: A multicentered, prospective, cohort study","volume":"149","author":"Xu","year":"2023","journal-title":"J Cancer Res Clin Oncol"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1835041\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T05:56:04Z","timestamp":1786514164000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1835041\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,12]]},"references-count":37,"alternative-id":["10.3389\/fimmu.2026.1835041"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1835041","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,12]]},"article-number":"1835041"}}