Emotional Distress and Pathologic Response in Locally Advanced Gastric/GEJ Adenocarcinoma

Inclusion Criteria:

1. Willing to participate in this study.
2. Age >18 years; both sexes are eligible.
3. Histologically confirmed gastric adenocarcinoma or gastroesophageal junction adenocarcinoma.
4. Resectable locally advanced disease as assessed by imaging and/or multidisciplinary team evaluation, generally corresponding to AJCC 8th edition stage II-III disease, including cT3-4a with any N category or any T with node-positive disease, without distant metastasis.
5. Planned to receive neoadjuvant therapy followed by curative-intent surgery.
6. Eastern Cooperative Oncology Group (ECOG) performance status of 0-1.
7. No prior systemic antitumor treatment for the current tumor at baseline.
8. Able to understand and complete questionnaire assessments.
9. Able and willing to provide written informed consent.

Exclusion Criteria:

1. Presence of distant metastasis, peritoneal metastasis, or loss of curative treatment opportunity as determined by clinical evaluation.
2. Prior neoadjuvant chemotherapy, immunotherapy, radiotherapy, or other systemic antitumor treatment for the current tumor.
3. Severe cognitive impairment, acute psychiatric disorder, or any condition that precludes completion of questionnaire assessments.
4. Current treatment with antidepressants, anxiolytics, or other psychotropic medications with any of the following within 4 weeks before baseline assessment: initiation, discontinuation, change in medication type, dose adjustment of 50% or more, or addition of a second or more psychotropic medication.
5. Any other condition judged by the investigator to make the participant unsuitable for enrollment.