Preoperative neoadjuvant chemotherapy on surgical condition and oncogene expression in advanced gastric cancer

Body composition: a crucial factor in downstaging and postoperative complications of neoadjuvant chemotherapy for gastric cancer

Background

Postoperative complications may lower the quality of life of patients, consequently leading to a reduction in their overall survival (OS). In our previous investigations, we found that patients with gastric cancer (GC) with postoperative complications who underwent direct surgery had a significantly lower OS than patients without complications. We observed no significant difference in OS among patients who underwent neoadjuvant chemotherapy (NAC), regardless of complications. We propose that for patients who underwent reoperation following NAC, downstaging (reduction of clinical stage) and postoperative complications exerted contrasting effects on the OS. Further, we hypothesize that post-NAC downstaging and the absence of postoperative complications lead to a longer OS.

Methods

We conducted a retrospective analysis to collect the clinical data of patients with GC who underwent surgery after receiving NAC at the First Hospital of Lanzhou University from January 2016 to December 2022. Based on the presence of a post-NAC downstaging period and postoperative complications, we categorized the patients into group A (downstaging without complications), group B (downstaging with complications), group C (non-downstaging with complications), and group D (non-downstaging without complications). First, we assessed the OS disparity between the groups. Subsequently, we performed a comparative analysis of the body composition and hematological indexes of patients from the four groups.

Results

We included 295 patients in the study and categorized them into four subgroups: group A comprised 83 patients (28.1%), group B comprised 32 patients (10.8%), group C comprised 83 patients (28.1%), and group D comprised 97 patients (32.9%). Group A patients had the longest OS of 40.1 ± 20.53, whereas group C patients had the shortest OS of 32.15 ± 25.09. The OS of patients in the other two groups was between these values. Pairwise comparisons revealed significant differences between the OS of group A patients and that of groups C (32.15 ± 25.09) and D (33.06 ± 20.89) patients (p < 0.05). The skeletal mass index (SMI) and skeletal mass area (SMA) were highest in group A, lowest in group C, higher in group A (SMI: 45.05 ± 7.44, SMA: 128.88 ± 22.67) than in group C (SMI: 41.61 ± 8.17, SMA: 115.56 ± 26.67) (p < 0.05), and higher in group D (SMI: 44.94 ± 6.87, SMA: 127.05 ± 23.09) than in group C (p < 0.05). However, we observed no significant difference between the SMI and SMA of groups B (SMI: 42.91 ± 9.68, SMA: 120.76 ± 30.51) and D (p > 0.05). With respect to hematological indexes, the prognostic nutritional index (PNI) was highest in group A and lowest in group C. The PNI in group A (417.89 ± 37.58) was significantly higher than that in group C (397.62 ± 47.56) (p < 0.05), and it was also higher in group D (410.76 ± 4.28) than in group C (p < 0.05). However, we observed no significant difference between the PNI in groups B (402.57 ± 53.14) and D (p > 0.05).

Conclusion

Patients with advanced GC who experienced post-NAC downstaging and no postoperative complication had the longest OS. Patients with better body composition demonstrated more significant downstaging, fewer postoperative complications, and a longer OS.

Efficacy and safety of refined nursing combined with Zhao's Thunder-Fire Moxibustion in treating patients with gastric cancer of Spleen-Qi Deficiency Syndrome: A clinical study

Objective

To investigate the efficacy and safety of refined nursing combined with Zhao's thunder-fire moxibustion in treating patients with gastric cancer (GC) of spleen-Qi deficiency syndrome.

Methods

This was a retrospective study. Ninety patients with GC of spleen-Qi deficiency syndrome admitted to Baoding Hospital of Traditional Chinese Medicine from February 2022 to March 2023 were randomly divided into the observation group and the control group. Patients in the control group were intervened with XELOX chemotherapeutic regimen + routine nursing. On this basis, patients in the observation group were additionally treated with refined nursing combined with Zhao's thunder-fire moxibustion. Changes in Traditional Chinese Medicine (TCM) syndrome scores, KPS scores for physical status, and quality of life (QOL) scores were observed and compared between the two groups before and after treatment.

Results

After treatment, the scores of anorexia, fatigue and weakness, postprandial abdominal bloating, loose stools, mental fatigue and laziness to speak decreased significantly in the two groups (P< 0.05), and each TCM syndrome score in the observation group was significantly lower than that in the control group (P< 0.05). After treatment, KPS and QOL scores in the observation group were significantly higher than those in the control group (P< 0.05). The overall nursing satisfaction was 93.3% (42/45) in the observation group, which was significantly higher than 71.1% (32/45) in the control group (P< 0.05).

Conclusion

Refined nursing combined with Zhao's thunder-fire moxibustion can alleviate the clinical symptoms of patients with GC of spleen-Qi deficiency syndrome, reduce chemotherapeutic-induced adverse reactions, with high clinical application value.

Clinical effects of neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy on complications and recurrence in patients with advanced gastric cancer

Objective

To compare the clinical effects of neoadjuvant chemoradiotherapy (NCRT) and neoadjuvant chemotherapy (NCT) on complications and recurrence in patients with advanced gastric cancer (AGC).

Method

This was a retrospective study. A total of 83 patients with AGC admitted to Chengde Central Hospital between Jan. 2019 and Jun. 2021 were selected and divided into the observation group(n=41) and the control group(n=42) using a random number table. Patients in the control group received XELOX chemotherapy, and those in the observation group received intensity-modulated radiotherapy (IMRT) with concurrent XELOX chemotherapy. Compared efficacy, pathological complete response rate (pCR), R0 resection rate, adverse reactions, and quality of life (QOL) before and after treatment between the two groups.

Results

The efficacy, pCR, and R0 resection rate of the observation group were significantly increased compared with those of the control group. Comparison of complications showed the number of patients experiencing gastrointestinal (GI) reactions, increased BUN, increased GPT, alopecia, and pigmentation in the observation group was decreased compared with that in the control group, with no statistically significant differences(p>0.05), and the number of patients experiencing myelosuppression was statistically significant between the two groups(p<0.05). There were no significant differences in sub-scores of physical, role, emotional, cognitive, and social functions and the overall score of QOL between the two groups(p>0.05) before treatment.

Conclusion

NCRT is safer and more effective in patients with AGC compared with NCT, and can significantly improve the QOL of patients. It can be widely used in clinical practice.

Efficacy and safety of perioperative therapy for locally resectable gastric cancer: A network meta-analysis of randomized clinical trials

BACKGROUND

Gastric cancer (GC) is the fifth most commonly diagnosed malignancy worldwide, with over 1 million new cases per year, and the third leading cause of cancer-related death.

AIM

To determine the optimal perioperative treatment regimen for patients with locally resectable GC.

METHODS

A comprehensive literature search was conducted, focusing on phase II/III randomized controlled trials (RCTs) assessing perioperative chemotherapy and chemoradiotherapy in treating locally resectable GC. The R0 resection rate, overall survival (OS), disease-free survival (DFS), and incidence of grade 3 or higher nonsurgical severe adverse events (SAEs) associated with various perioperative regimens were analyzed. A Bayesian network meta-analysis was performed to compare treatment regimens and rank their efficacy.

RESULTS

Thirty RCTs involving 8346 patients were included in this study. Neoadjuvant XELOX plus neoadjuvant radiotherapy and neoadjuvant CF were found to significantly improve the R0 resection rate compared with surgery alone, and the former had the highest probability of being the most effective option in this context. Neoadjuvant plus adjuvant FLOT was associated with the highest probability of being the best regimen for improving OS. Owing to limited data, no definitive ranking could be determined for DFS. Considering nonsurgical SAEs, FLO has emerged as the safest treatment regimen.

CONCLUSION

This study provides valuable insights for clinicians when selecting perioperative treatment regimens for patients with locally resectable GC. Further studies are required to validate these findings.

New strategy in hemorrhagic gastric cancer: A case report of complete pathological remission after neoadjuvant chemotherapy

RATIONALE

Strategy for hemorrhagic gastric cancer should both handle the potential life-threatening situation caused by bleeding and increase probability of long-term survival. For hemorrhagic patients with locally advanced gastric cancer, surgical resection is always the preferred option for the reason that it eliminates both the tumor and risk of rebleeding. However, the long-term survival after resection is still unsatisfactory.

PATIENT CONCERNS

Here, we report a patient with hemorrhagic locally advanced gastric cancer achieved pathological complete response after neoadjuvant chemotherapy.

DIAGNOSES

In this case, a 58-year-old man presenting with gastrointestinal hemorrhage and hemodynamic instability was admitted to the emergency department. Gastroscopy and biopsy revealed a large hemorrhagic ulcerated carcinoma located in the antrum, gastric angle, and lower part of gastric body. Abdominal CT indicated an infiltrative ulcerated carcinoma with perigastric lymph nodes metastasis.

INTERVENTIONS

After fluid resuscitation, blood transfusion, application of proton pump inhibitors, and Octreotide, the patient recovered gradually. Then, nasojejunal feeding tube was placed for enteral nutrition and tumor exclusion. Subsequently, the patient received 5 cycles of neoadjuvant S-1 plus oxaliplatin regimen, without signs of rebleeding, followed by radical distal gastrectomy.

OUTCOMES

Pathological examination confirmed that the patient received pathological complete response.

LESSONS

This case suggests that neoadjuvant chemotherapy is feasible in selected hemorrhagic gastric cancer patients and tumor exclusion is helpful in reducing rebleeding risk.

Clinical effects of Apatinib combined with DOS neoadjuvant chemotherapy regimen in neoadjuvant chemotherapy for LAGC

Objective

To evaluate the clinical effects of apatinib combined with DOS regimen in the neoadjuvant chemotherapy for locally advanced gastric cancer (LAGC).

Methods

Eighty patients with LAGC admitted to Baoding first Central Hospital from January 2018 to October 2020 were randomly divided into two groups (n=40, respectively). The control group received DOS chemotherapy regimen alone. The experiment group additionally orally took apatinib mesylate tablets. The changes in CEA, CA19-9 and other tumor markers, RO resection rate, incidence of operative complications, adverse reactions, and other indicators were compared between the two groups.

Results

The overall response rate (ORR) of the experimental group was 72.5%, which was significantly better than that of the control group (50%) (p=0.03). After the treatment, the CEA and CA19-9 in the experiment group were significantly lower than those in the control group (p=0.00). The Ro resection rate was 77.5% in the experiment group and 57.5% in the control group (p=0.03). The operation time was shortened and amount of bleeding decreased in the experiment group, and the differences were statistically significant (p=0.00). The incidence of surgical complications in the experimental group was 17.5%, significantly lower than that in the control group (37.5%) (p=0.04).

Conclusion

Apatinib combined with DOS regimen is effective for patients with LAGC without significantly increasing adverse reactions. Meanwhile, tumor markers are reduced significantly. Besides, the Ro resection rate and the incidence of operative complications are obviously superior to the DOS neoadjuvant chemotherapy regimen alone.

Clinical efficacy of immunotherapy combined with chemotherapy in patients with advanced gastric cancer, its effect on nutritional status and Changes of peripheral blood T lymphocyte subsets

OBJECTIVES

To evaluate the clinical efficacy of immunotherapy combined with chemotherapy in patients with advanced gastric cancer and its effect on nutritional status and changes of peripheral blood T lymphocyte subsets.

METHODS

Sixty patients with locally advanced gastric cancer who were admitted by Affiliated Hospital of Hebei University from March 2020 to February 2021 were enrolled and randomly divided into two groups, with 30 cases in each group. The control group was treated with FOLFOX4 chemotherapy, while the experimental group was additively treated with cindilizumab on the basis of control group. The incidence of adverse reactions, clinical efficacy, improvement of nutritional and physical status, and changes in the levels of T lymphocyte subgroups in the two groups were compared and analyzed.

RESULTS

The total effective rate was 70% in the experimental group, which was better than 43.3% of the control group (p=0.04). The improvement rate of performance status (ECOG) score and nutritional indicators in the experimental group was significantly better than that in the control group (p<0.05). Moreover, the indicators of CD3+, CD4+, CD4+/CD8+ in the experimental group were significantly higher than those in the control group after treatment, with statistically significant differences (CD3+, p=0.01; CD4 +, p= 0.02; CD4+/CD8+, p=0.01).

CONCLUSION

Immunotherapy combined with chemotherapy has a significant effect on locally advanced gastric cancer patients, with significant improvement in physical strength and nutritional status, significant improvement in T lymphocyte function, and no obvious adverse reactions. It is worth promoting in clinical application.

A Retrospective Study of Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer

Objective

To explore the efficacy and safety of neoadjuvant chemotherapy in the doublet and triplet regimens of locally advanced gastric cancer.

Patients and Methods

A retrospective analysis was conducted on 162 patients with gastric cancer who received neoadjuvant chemotherapy, including 74 patients receiving doublet regimen (fluorouracil/platinum) and 88 patients receiving triplet regimen (fluorouracil/platinum/Taxol). Patients in both groups received neoadjuvant chemotherapy for two cycles, and underwent surgical resection 4 weeks after the end of chemotherapy.

Results

The total clinical remission rate was 68.6% (105/153), the phase-down rate was 46.4% (71/153), and the pathological response rate was 59.9% (97/162). In the doublet and triplet regimen, the clinical remission rate was 65.7% (44/67) and 70.9% (61/86) (P = 0.708), the descending period rate was 41.8% (28/67) and 50.0% (43/86) (P = 0.485), and the pathological response rate was 51.4% (38/74) and 67.0% (59/88) (P = 0.190). The median disease-free survival (DFS) and overall survival (OS) of 162 patients were 36.0 and 58.5 months. In the doublet and triplet regimen, the median DFS was 38.0 and 34.0 months (P = 0.377), and the median OS was 59.0 and 56.5 months (P = 0.256). The side effects of the doublet group were significantly lower than those of the triplet group, with leucopenia rate of 45.9% (34/74) and 62.5% (55/88) (P = 0.035); thrombocytopenia rate of 18.9% (14/74) and 35.2% (31/88) (P = 0.021); nausea rate of 45.9% (34/74) and 64.8% (57/88) (P = 0.016), and diarrhea rate of 1.4% (1/74) and 9.1% (8/88) (P = 0.032).

Conclusion

Neoadjuvant chemotherapy is safe and effective for locally advanced gastric cancer. The clinical efficacy of neoadjuvant chemotherapy in the doublet group and the triplet group is equivalent, and the doublet group has better safety and tolerance.

Laparoscopic Gastric Resection for Gastric Cancer: Is Intracorporeal Anastomosis Necessary?

BACKGROUND AND OBJECTIVE

In surgical dissection, laparoscopic approach and open techniques do not differ significantly, but there is still no consensus on how anastomosis should be performed in both cardia and distal gastric tumors. Anastomosis can be performed by laparoscopy-assisted mini-laparotomy or by intracorporeal suture techniques. In this study, we aim to present our four years of clinical experience and short-term surgical results from 133 cases in order to evaluate the necessity of laparoscopic anastomosis.

METHODS

This study was approved by Ethics Committee (No: 1-8-19, date: 14/01/2019). Patients who underwent curative resection with the diagnosis of gastric adenocarcinoma between January 2014 and January 2018 in the Ankara University Surgical Oncology Department were included in the study.

RESULTS

Of the 133 patients included in the study, 108 (81.2) were male and the mean age was 60.51 ± 12.0 years. The time of anastomosis was significantly longer in patients undergoing intracorporeal anastomosis (p = 0.021). The incidence of anastomotic leakage was significantly higher in the group undergoing intracorporeal anastomosis (p = 0.004).

CONCLUSIONS

We think that esophagojejunostomy and jejunojejunostomy anastomoses in patients undergoing total gastrectomy should be performed with intracorporeal techniques in terms of benefit risk assessment. We believe that it is more feasible to continue the case with mini laparotomy when anastomosis is reached in patients who are planned to have gastrojejunostomy. In addition, in terms of intracorporeal anastomoses and advanced laparoscopic techniques, intracorporeal anastomoses performed in gastric cancer surgery for a laparoscopist who has completed the learning curve do not appear to be very different in terms of anastomosis safety.