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IMPORTANCE Apatinib is a novel treatment option for chemotherapy-refractory advanced gastric cancer (GC), but it has not been evaluated in patients with locally advanced GC.OBJECTIVE To investigate the effectiveness and safety of apatinib combined with S-1 plus oxaliplatin (SOX) as a neoadjuvant treatment for locally advanced GC. DESIGN, SETTING, AND PARTICIPANTSThis multicenter, prospective, single-group, open-label, phase 2 nonrandomized controlled trial was conducted in 10 centers in southern China. Patients with M0 and either clinical T2 to T4 or N+ disease were enrolled between

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Key Points Question Is adjuvant chemotherapy associated with a survival benefit for patients with locally advanced gastric cancer who underwent curative-intent gastrectomy after neoadjuvant chemotherapy? Findings In this cohort study of 462 patients with locally advanced gastric cancer from Western and Eastern countries, adjuvant chemotherapy was associated with significantly improved survival in patients with a lymph node ratio of at least 9% compared with those who did not receive adjuvant chemotherapy. Meaning These findings suggest that the lymph node ratio could be useful in adjuvant chemotherapy selection for locally advanced gastric cancer after neoadjuvant chemotherapy in future decision-making processes.