Objective To investigate the clinical effects and safety differences of open surgery and laparoscopy primary lesion resection combined with D2 lymph node dissection in the treatment of elderly patients with advanced gastric cancer. Methods One hundred and forty elderly patients with advanced gastric cancer were chosen and randomly divided into two group including open operative group (70 patients) with primary lesion resection combined with D2 lymph node dissection by open operation and laparoscopic surgery group (70 patients) with primary lesion resection combined with D2 lymph node dissection by laparoscopy; and the operative time, intraoperative bleeding amount, the levels of PaCO2 in operation, liquid diet eating time, postoperative anal exhaust time, postoperative gastric tube indwelling time, postoperative ambulation time, the level of haemoglobin (Hb) after operation, the hospitalization time, the number of lymph node dissection, the survival rate with followed-up and postoperative complication incidence of both groups were compared. Results There was no significant difference in the operative time between 2 groups (P>0.05). The intraoperative bleeding amount, the level of PaCO2 in operation, liquid diet eating time, postoperative anal exhaust time, postoperative gastric tube indwelling time, postoperative ambulation time, the level of Hb after operation and the hospitalization time of laparoscopic surgery group were significantly better than open operative group (P<0.05). The level of PaCO2 in operation of laparoscopic surgery group was significantly higher than open operative group (P<0.05). There were no significant difference in the gastric lymph node dissection number and the peripheral lymph node dissection number of gastric artery between 2 groups (P>0.05). There were no significant difference in the survival rates between the 2 groups after 3-year followed-up (P>0.05). The complication incidence after operation of laparoscopic surgery group was significantly lower than open operative group (P<0.05). The quality of life scores of patients in laparoscopic surgery group were significantly higher than those in open operative group on 7 days and in 3 months after operation, and the difference were statistically significant (P<0.05). Conclusion Compared with open operation, primary lesion resection combined with D2 lymph node dissection by laparoscopy in the treatment of elderly patients with advanced gastric cancer can efficiently possess the advantages including minimally invasive, shorter recovery time and less postoperative complications.
ObjectiveTo evaluate the influence of pathological differentiation in the effect of preoperative chemo-therapy for patients with locally advanced gastric cancer (LAGC). MethodsThirty-two patients with LAGA received preoperative chemotherapy with oxaliplatin and capecitabine (XELOX regimen).According to the pathological examina-tion, patients were classified into better (well and moderate, 16 cases) and poorly (16 cases) differentiated groups, and the clinical response rate, type of gastrectomy, and negative tumor residual rate were compared between the two groups.Morphological changes and toxic reactions were monitored after chemotherapy. ResultsThe results showed that the clinical response rate in the better differentiated group was significantly higher than that in the poorly differentiated group (100% vs.6.4%, P=0.000).The partial gastrectomy rate in the better differentiated group was significantly higher than that in the poorly differentiated group (87.5% vs.25.0%, P=0.000).A significant shrinking of tumor size and necrosis of tumor tissues caused by chemotherapy could be observed. ConclusionThe better differentiated group with locally advanced gastric cancer is suitable for preoperative chemotherapy with XELOX regimen, and as a result of effective preoperative chemotherapy, much more gastric tissue can be preserved for better differentiated group.
ObjectiveTo explore the clinical value of immunotherapeutic drugs represented by programmed cell death-1 (PD-1) / programmed cell death ligand-1 (PD-L1) blockades for treatment of advanced gastric cancer. MethodThe latest literatures about the clinical studies of PD-1/PD-L1 blockades for the treatment of advanced gastric cancer were retrieved and reviewed. ResultsThe corresponding clinical trials relevant to PD-1/PD-L1 blockades had been conducted in the treatment, biomarkers, and resistance to drugs for advanced gastric cancer. The PD-1/PD-L1 blockades single drug or its in combination with chemical drugs or (and) targeted drugs for the treatment of advanced gastric cancer or gastroesophageal junction cancer had shown a good efficacy in some patients. The patients who benefited from PD-1/PD-L1 blockades might be a population with specific molecular characteristics, but the resistance to drugs during the therapy process affected its therapeutic effect. ConclusionFrom the progress of this review, PD-1/PD-L1 blockades bring benefits to some patients with advanced gastric cancer, but more biomarkers which can predict the therapeutic effect need to be found to optimize the drug regimen, and the resistance to drugs mechanism needs to be further studied.
摘要:目的：观察复方苦参注射液配合化疗治疗晚期胃癌的临床疗效。方法：将60例晚期胃癌患者分为两组,两组均采用FOLFOX方案化疗,21天为1个周期；2个周期评价效疗。治疗组30例加用复方苦参注射液治疗,14天为1疗程,2个疗程评价疗效。观察近期疗效及临床证候变化、生存质量及毒副反应变化。结果:两组近期疗效比较,治疗组与对照组总缓解率分别为433%和400%（P＞005）；两组临床证候变化比较,治疗组与对照组总改善率分别为800%和600%（P＜005）；两组生存质量变化比较,治疗组与对照组提高稳定率分别为867%和567%（P＜005）；中位生存期分别为8个月和5个月；两组毒副反应比较,治疗组毒副反应明显低于对照组（P＜005）。结论:复方苦参注射液配合化疗治疗晚期胃癌具有一定抗肿瘤作用,能缓解疼痛症状及临床症状,减轻化疗毒副反应,提高生活质量,延长生存期。Abstract: Objective: To study the effect of combination FuFang Ku Shen Zhusheye and chemotherapy for treatment of advanced gastric cancer. Methods: Sixty patientswith advanced gastric cancer were divided into two groups, all used with FOLFOXregimen, 21 days a cycle; twocycle assessment of treatment effect. The treatment group were treated with the FuFang Ku Shen Zhusheye plus treatment, a course of treatment for 14 days, the effect were evaluated after two courses. The clinical symptoms and living quality, toxicity were dynamically observed. Results: Both shortterm effect of comparison, the overall response rates of the treatment group and the control group were 433% and 400% (P＞005); The rates of clinical symptoms of the treatment group and the controlgroup were 800% and 600% respectively (P＜005); the rates of increasing of living quality were respectively 867% and 567% (P＜005); the median survival time was 8 months and 5 months; the toxicity of the treatment group was significantly lower than that of the control group (P ＜005).Conclusion: Treating advanced gastric cancer by use of FuFang Ku Shen Zhusheye combination with chemotherapy is helpful to reducing the pain symptoms, promoting the clinical symptoms, reducing the chemotherapy side effects, improving quality of life and prolonging the survival time.
Objective To evaluate clinical efficacy of mFOLFOX6 combined with aspirin in treatment of advanced gastric cancer following perioperative period of laparoscopic distal subtotal gastrectomy. Methods One hundred and seven patients with advanced gastric cancer were assigned to observation group (57 cases) and control group (50 cases). The patients in the observation group received the mFOLFOX6 chemotherapy and regular intake of aspirin (100 mg/d) and the control group received the mFOLFOX6 chemotherapy alone. The recurrence or metastasis rate, rate of disease progress, toxicity, median survival time, and 3-year survival rate were compared between the observation group and the control group. Results ① There were no significant differences in the gender, age, pathological type, and so on between the observation group and the control group (P>0.05). ② The rates of toxicity such as the white blood cell reduction, granulocyte reduction, thrombocytopenia had no significant differences in these two groups (P>0.05). ③ The follow-up time was 4–45 months with an average 3.5 years, the rate of disease progress was lower (P=0.032), the median survival time was longer (P=0.043), the cumulative 3-year overall survival (P=0.015) and the cumulative 3-year disease-free survival (P=0.037) were better in the observation group as compared with the control group. Conclusion Preliminary results in this study show that mFOLFOX6 regimen combined with low-dose aspirin could significantly improve efficacy of advanced gastric cancer following perioperative period of laparoscopic distal subtotal gastrectomy, reduce rate of disease progress, and improve survival rate without increasing side effects.
ObjectiveTo study value of long noncoding RNA H19 and HOTTIP in plasma in predicting efficacy of neoadjuvant chemotherapy (NAC) for resectable locally advanced gastric cancer. MethodsForty patients with T3–4aN+M0 gastric cancer and 40 patients with benign gastric diseases treated in the Yantai Yuhuangding Hospital Affiliated to Qingdao University from August 2020 to May 2021 were prospectively included. The expressions of H19 and HOTTIP in the plasma of gastric cancer and benign gastric diseases patients without any treatment after admission were detected before treatment (CAPEOX regimen was used in the patients with gastric cancer), then which were detected after 2 NAC courses for patients with gastric cancer. Meanwhile, some clinical items were detected and the efficacy of NAC was evaluated. The complete remission (CR) and partial remission (PR) were classified as objective remission, CR, PR, and disease stability were classified as disease control. The expressions of H19 and HOTTIP between the different patients were compared and the receiver operating characteristic (ROC) curve was used to evaluate their values in the diagnosis of resectable locally advanced gastric cancer. ResultsThere were 13 cases of T downstaging and 27 cases of T non-downstaging and 25 cases of objective remission and 35 disease control after NAC. The median relative expression levels of H19 and HOTTIP before NAC in the patients with gastric cancer were higher than those in the patients with benign gastric diseases (H19: 1.42 versus 0.98, Z=–3.835, P<0.001; HOTTIP: 2.15 versus 1.04, Z=–5.062, P<0.001), and which were in the patients with T downstaging and disease control were lower than those in the patients with T non-downstaging and 5 cases of disease progression (For T staging, H19: 1.12 versus 1.54, Z=–2.960, P=0.002; HOTTIP: 1.49 versus 2.30, Z=–2.310, P=0.019. For efficacy of NAC, H19: 1.39 versus 2.48, Z=–3.211, P<0.001; HOTTIP: 1.96 versus 3.25, Z=–2.393, P=0.014). The median relative expressions of H19 and HOTTIP after NAC were lower than those before NAC in the patients with gastric cancer (H19: 1.12 versus 1.42, Z=–3.965, P<0.001; HOTTIP: 1.30 versus 2.15, Z=–4.839, P<0.001). There were no significant differences in the changes of H19 and HOTTIP before and after NAC between the patients with T downstaging and T non-downstaging, and between disease control and disease progression (P>0.05). The areas of ROC curve of H19, HOTTIP, and combination of H19 and HOTTIP in diagnosis of resectable locally advanced gastric cancer were higher than 0.7. ConclusionsLncRNA H19 and HOTTIP might be potential tumor markers in gastric cancer, and their diagnostic values for resectable locally advanced gastric cancer are higher. Gastric cancer patients with low expressions of H19 and HOTTIP in plasma might be more sensitive to NAC.
ObjectiveTo evaluate prognostic value of change of immune status in locally advanced gastric cancer (LAGC) patients. Methods We retrospective collected 210 LAGC patients who underwent treatment in our department from January 2013 to December 2018, then we collected lymphocyte-to-monocyte ratio (LMR) and cLMR (change of lymphocyte-to-monocyte ratio, cLMR) before operation and after three cycles of adjuvant chemotherapy. We had developed a new immune state change score (ICS) based on preoperative LMR (pLMR) and cLMR, and explored its prognostic value. The definition of ICS in this study was: ICS=1, pLMR≤4.53 and cLMR≤1; ICS=2, pLMR≤4.53 and cLMR>1, or pLMR>4.53 and cLMR≤1; ICS=3, pLMR>4.53 and cLMR>1. Results The results of multivariate Cox proportional hazard regression model showed that ICS was an influencing factor for overall survival [ICS=2, RR=0.397, 95%CI (0.260, 0.608), P<0.001; ICS=3, RR=0.080, 95%CI (0.040, 0.162), P<0.001), patients with ICS scores of 2 and 3 had better overall survival. In addition, the prognostic accuracy of ICS was superior to pLMR and Clmr, and the C-index of ICS [0.806, 95%CI (0.746, 0.865)] was higher than that of pLMR [0.717, 95%CI (0.635, 0.799), P=0.003)] and cLMR [0.723, 95%CI (0.641, 0.806), P=0.005)]. Based on this, a Nomogram model included ICS, CEA, and pTNM staging was constructed to predict the 3-year and 5-year survival rates of patients. The calibration curve and C-index [0.821, 95%CI (0.783, 0.859)] showed high discrimination and accuracy of Nomogram, and decision curve analysis confirmed that the model had good clinical application value. Conclusions The dynamic changes in the patient’s immune status before and after adjuvant therapy are related to the overall survival of LAGC patients. As an evaluating system which combined the cLMR and pLMR, ICS can better predict the prognosis of LAGC patients.
ObjectiveTo summarize controversy and progress of multi-slice spiral CT in efficacy evaluation of transformation therapy for advanced gastric cancer.MethodThe recent studies published at home and abroad on the spiral CT in evaluating the therapeutic effect of transformation therapy for the advanced gastric cancer were reviewed and analyzed.ResultsIn recent years, though the energy spectrum and dual-energy CT examinations had appeared, the most common tool in evaluating of the efficacy of transformation therapy for the advanced gastric cancer was the spiral CT. The most common evaluation standard was still the RECIST standard.ConclusionsSpiral CT has its outstanding diagnostic significance in therapeutic evaluation of transformation therapy for advanced gastric cancer. Although there is some controversy, with advancements of a large number of studies, it will greatly help diagnosis and treatment of advanced gastric cancer.
ObjectiveTo assess the outcomes of laparoscopy-assisted surgery for treatment of advanced gastric cancer.MethodsA total of 115 patients with advanced gastric cancer were included between January 2014 and December 2018 were analyzed retroprospectively, the patients were divided into two groups: open surgery group (OS group, n=63) and laparoscopy-assisted surgery group (LAS group, n=52). Baseline characteristics, intraoperative parameters and postoperative items, and long-term efficacy were compared between the two groups.ResultsThere was no significant difference in preoperative baseline data including gender, age and preoperative serum parameters between the two groups (P>0.05). Intraoperative blood loss in the LAS group was significantly less than that in the OS group (P<0.05). In addition, the first feeding time after operation and postoperative hospital stay in the LAS group were significantly shorter than the OS group (P<0.05). Furthermore, numbers of white blood cells and neutrophils in the LAS group were fewer than that in the OS group at postoperative 2 days (P<0.05); the level of serum albumin in the LAS group was higher than that OS group (P<0.05). The number of lymph nodes detected during operation in the LAS group was more than that in the OS group (P<0.05). Operative time and occurrence of postoperative complications were not statistically significant between the two groups (P>0.05). One hundred and ten of 115 patients were followed- up, the follow-up rate was 95.7%. The follow-up time ranged from 6 to 48 months, with a median follow-up time of 12.4 months. The disease-free survival time of the OS group was 12.2±6.5 months, while that of the LAS group was 13.5±7.4 months. There was no significant difference between the two groups (P>0.05).ConclusionsLaparoscopic technique in treatment of advanced gastric cancer has the minimally invasive advantage, less intraoperative blood loss, less surgical trauma, and faster postoperative recovery in comparing to the traditional open surgery. Also the lymph node dissection is superior to open surgery. The curative effect is comparable to that of open surgery.
Objective To explore clinicopathologic features and prognostic factors of different pathological types of advanced gastric cancer. Methods The clinicopathologic data of 98 patients with advanced gastric cancer who underwent radical gastrectomy in Suqian People’s Hospital, Nanjing Drum Tower Hospital Group, Affiliated to Nanjing University Medical School in 2011 were analyzed retrospectively. There were 53 cases of gastric adenocar-cinoma, 30 cases of mucinous adenocarcinoma, and 15 cases of signet ring cell carcinoma among them. The differences of clinicopathologic characteristics and prognosis were compared among different pathological types of advanced gastric cancer. Results ① There were no significant differences in terms of the gender, age, nerve invasion, and degree of differentiation among the three groups (P>0.05), there were significant differences in terms of the tumor diameter, tumor location, radical surgery type, regional lymph node metastasis, lymphatic cancer embolus, depth of invasion, and pTNM stage among the three groups (P<0.05). ② The results of the univariate analysis showed that the prognosis of gastric adenocarcinoma was associated with the tumor diameter, tumor location, radical surgery type, regional lymph node metastasis, depth of invasion, or pTNM stage (P<0.05); the prognosis of mucinous adenocarcinoma was associated with the radical surgery type, regional lymph node metastasis, or pTNM stage (P<0.05); the prognosis of signet ring cell carcinoma was associated with the regional lymph node metastasis, depth of invasion, and pTNM stage (P<0.05). ③ The results of the Cox multivariate analysis showed that the tumor location (P=0.016), regional lymph node metastasis (P=0.042), invasion depth (P=0.021), and pTNM stage (P=0.009) were the independent risk factors of prognosis for the gastric adenocarcinoma; the regional lymph node metastasis was the independent risk factor of prognosis for gastric mucinous adenocarcinoma (P=0.000); the tumor invasion depth (P=0.032) and regional lymph node metastasis (P=0.002) were the independent risk factors of prognosis for signet ring cell carcinoma. ④ The follow-up time was 60 months. The median follow-up time was 32 months in the gastric adenocarcinoma, 43 months in the mucinous adenocarcinoma, 23 months in the signet ring cell carcinoma, the 5-year accumulated survival rate was 30.2%, 23.3%, and 26.7% respectively. The comparison of survival curves of these three different pathological types of gastric cancer had no significant difference (P=0.131). Conclusion Clinical and pathological features of patients with different pathological types of advance gastric cancer present some differences, and prognostic factors are also different, but regional lymph node metastasis is a common prognostic factor for different pathological types of advanced gastric cancer.