e16022 Background: Peritoneal metastasis is the most common metastatic mode of advanced gastric cancer, which is prone to poor prognosis and is also one of the common causes of death in patients with distant gastric cancer metastasis.The purpose of this paper was to establish a new hematologic scoring (an NPD scoring) by the neutrophil-lymphocyte ratio (NLR) and platelet- lymphocyte ratio (PLR) A and D-dimer (DDI), and its association with the peritoneal cancer index (PCI) was evaluated, and the ability of NPD scoring system to judge the prognosis of peritoneal metastasis of gastric cancer. Methods: This was a single-center, nonrandomized, retrospective, cohort study.102 patients with peritoneal metastasis of gastric cancer who underwent diagnostic staging laparoscopy (DSL) were enrolled and assessed with PCI scores.. According to the first PCI (PCI < 15), the patients were divided into low PCI group (n = 67) and high PCI group (n = 35). Through univariate analysis and multivariate analysis, it was found that NLR, PLR and DDI were related to high PCI (≥ 15), and NPD scoring system was established. Chi-square test was used to evaluate the relationship between NPD score, PCI and prognosis. Results: The cohort study found that the differences of NLR, PLR and DDI between low PCI group (n = 67) and high PCI group (n = 35) were statistically significant (P < 0.05). Univariate and multivariate analysis showed that NLR, PLR and DDI were independent risk factors for high PCI (P < 0.05). The NPD score of patients in the high PCI group was significantly higher than those in the low PCI group (P = 0.001). The survival rate of patients in high-risk group (NPD ≥ 2 points) was significantly lower than that in low-risk group (NPD < 2 points) (P = 0.003). Multivariate analysis showed that PCI and NPD score ≥ - 2 were independent predictors of OS. Conclusions: NPD score can be used as a blood marker to predict PCI and prognosis in patients with peritoneal metastasis of gastric cancer, and to guide clinical treatment. This new scoring system is an economic and convenient tool for predicting PCI and judge the prognosis of peritoneal metastasis.
e16012 Background: Gastric cancer is the fifth most common cancer in the world and the third leading cause of cancer death. At present, traditional chemotherapy is still the main treatment method of advanced gastric cancer, but the efficacy is limited. Immunotherapy has been identified as a treatment for chemotherapy-refractory gastric cancer, and sintilimab is a fully human IgG4 monoclonal antibody that binds to programmed cell death receptor-1 (PD-1). This study aims to investigate the efficacy of sintilimab combined with chemotherapy in patients with inoperable metastatic gastric cancer and analyze the prognostic factors of these patients. Methods: Patients with advanced gastric cancer which were initially treated unresectable and with distant metastasis in Zhejiang Cancer Hospital from August 2018 to December 2021 were retrospectively analyzed in this research. Patients received sintilimab combined with chemotherapy (PS regimen) :sintilimab 200mg, day 1, paclitaxel was administered intravenously (150 mg/m2 ) on day 1, and S-1 was administered orally (80 mg/m2/day) on days 1–14 of a 3-week cycle. The primary endpoints were treatment efficiency; and the secondary endpoint was safety and overall survival (OS) time. Results: A total of 66 patients were enrolled, including 43 males and 23 females, with an average age of 62.2 years (29-77 years). All of these patients had one or more distant metastases (liver 28 cases, peritoneum 20 cases, retroperitoneal lymph node 21 cases and ovary 5 cases). 33 patients (50%) underwent surgery, including conversion surgery (26 cases), palliative surgery (7 cases). The mean OS of patients with conversion surgery was 19.2 months (95%CI 16.5̃21.9 months), and the 2-year survival rate was 50.0%. The mean OS of non-conversion surgery was 16.9 months (95%CI 12.9̃20.1 months), and the 2-year survival rate was 29.1% (P=0.028). 24 (92.3%) cases had R0 resection. Multivariate analysis showed that postoperative CA125 level was an independent risk factor for prognosis of these gastric cancer patients. Conclusions: Sintilimab combined with chemotherapy is safe and effective, and combined with conversion surgery can improve the prognosis of patients with partially unresectable advanced gastric cancer.
e16064 Background: Borrmann type IV gastric cancer is highly malignant and prone to peritoneal metastasis, including peritoneal dissemination (P1) and positive peritoneal cytology (CY1) causing a dismal prognosis. This study is to compare the efficacy of neoadjuvant chemotherapy and postoperative adjuvant chemotherapy in patients with Borrmann type IV gastric cancer and analyze the prognostic factors of these patients. Methods: According to different therapies, patients diagnosed with Borrmann type IV gastric cancer in Zhejiang Cancer Hospital from June 2010 to June 2020, were divided into two groups: neoadjuvant chemotherapy group (NCT group) and non-neoadjuvant chemotherapy group (NNCT group). Both of two groups were subjected to the propensity score matching (PSM) at a ratio of 1:2 and then the treatment completion rate and overall survival (OS) time were analyzed. Results: A total of 240 cases were included after propensity score matching and 80 patients and 160 patients were enrolled in the NCT group and NNCT group, respectively. Neoadjuvant chemotherapy and postoperative adjuvant chemotherapy were based on platinum combined with fluorouracil. For the efficacy of treatment, R0 resection was performed on 92.2% patients in the NCT group and 88.1% in the NNCT group, but there was no statistical difference (P=0.463). 3-year survival rate was 35.0% in the NCT group compared with 29.4% in the NNCT group (P=0.427), and the 5-year survival rate was 28.7% and 25.6%, respectively (P=0.460). For patients with and without R0 resection, the 3-year survival rate was 34.3% and 7.4% (P<0.001), and the 5-year survival rate was 30.0% and 0%, respectively (P<0.001). Hyperthermic intraperitoneal chemotherapy (HIPEC) was conducted on 40 patients (16.7%), and the survival rate of HIPEC group was better than that of non-HIPEC group (3 year survival rate: 55.0% vs 26.5%, P=0.073; 5 year survival rate: 45.0% vs 23.0%, P=0.174), but the difference was not statistically significant. Conclusions: Borrmann type IV gastric cancer was characterized by poor differentiation and high incidence of peritoneal metastasis. The efficacy of the neoadjuvant chemotherapy based on platinum combined with fluorouracil is limited. A combination of HIPEC and system chemotherapy may effectively improve the prognosis of these patients.
e16041 Background: Hepatic metastases of gastric cancer(HMGC) are an important factor affecting the prognosis of gastric cancer patients, and 3-14% of gastric cancer cases were diagnosed with synchronous hepatic metastases of gastric cancer (SHMGC). However, there remains much unidentified about the therapy effect of surgical resection on SHMGC. Here, we investigated the associations of surgical resection with the overall survival of SHMGC, which might develop more effective therapy strategies for patients of HMGC. Methods: Patients diagnosed with SHMGC from January 2010 to December 2015 were selected in the study. Kaplan-Meier analysis and multivariable analysis based on the Cox proportional hazards model were performed to compare the effects of surgical resection (including gastrectomy and metastasectomy) combined with chemotherapy (surgical resection group, SR group) and palliative chemotherapy (palliative chemotherapy group, PC group) on survival. Results: A total of 132 patients were enrolled in this study. Overall, 57 (43.2%) were treated with surgical resection/chemotherapy and 75 (56.8%) palliative chemotherapy. Overall survival (OS) was significantly prolonged in the SR group compared with the PC group (33.6 vs. 12.4 months, P < 0.001). In the SR group, the R0 resection (68.4%, 39/57) contributed to markedly prolonged OS compared with the non-R0 resection subgroup (45.1 vs. 13.5 months, P < 0.001). Surgical resection and single hepatic metastasis were independent predictors of OS in multivariate analysis with hazard ratio (HR) of 0.453 (95% confidence interval [CI] 0.276-0.813, p = 0.009) and 0.540 (95%CI 0.315-0.796, p = 0.043), respectively. Conclusions: For patients with synchronous hepatic metastases of gastric cancer, radical surgical resection combined with appropriate chemotherapy may be more beneficial than palliative chemotherapy. Moreover, single hepatic metastasis might achieve better survival after aggressive surgical resection.
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