Neoadjuvant Therapy for Gastric Adenocarcinoma with Signet Ring Cells: A Systematic Review and Meta-Analysis

Signet ring cell-containing gastric cancer constitutes an increasingly recognized subtype. Although perioperative chemotherapy is the standard of treatment for locally advanced gastric cancer, its efficacy in signet ring cell-containing gastric adenocarcinomas remains controversial. This systematic review and meta-analysis aims to assess the impact of neoadjuvant chemotherapy compared to upfront surgery on overall survival.

A systematic search of MEDLINE, Scopus, and Cochrane was conducted up to January 2026. Eligible studies included adult patients with signet ring cell-containing gastric cancer undergoing neoadjuvant chemotherapy followed by surgery compared to upfront gastrectomy. A random-effects meta-analysis was performed to pool hazard ratios for overall survival.