Neoadjuvant apatinib-based regimens achieve 93% R0 resection rate in resectable gastric and esophageal junction cancersApatinib shows promise for patients with gastric and esophageal cancer

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. 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. 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. 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. https://www.crd.york.ac.uk/prospero/, identifier CRD42023478481.