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.
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.
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 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 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.
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.
ObjectiveTo explore the value of multi-slice spiral CT (MSCT) in the judgment of N stage and lymph node metastasis of patients with advanced gastric cancer who underwent surgery after transformation therapy.MethodsClinical data of 27 patients with advanced gastric cancer who underwent surgery after transformation therapy, form July 2017 to July 2019 in Affiliated Yantai Yuhuangding Hospital of Qingdao University were analyzed retrospectively, and all of patients underwent SOX regimen transformation therapy. The MSCT enhanced scan was performed before operation, and the postoperative pathology was used as the gold standard. The preoperative N stage and lymph node metastasis groups were evaluated by MSCT enhanced scan and compared with the pathological results.Results Before the operation, MSCT was used to evaluate the lymph node metastasis of the patients with advanced gastric cancer after transformation therapy, and compared with the lymph nodes metastasis of the corresponding pathological results, the accuracy rates of lymph node groups in No.1, No.3, No.5, No.6, No.7, No.8, and No.16 were 77.78% (21/27), 81.48% (22/27), 85.19% (23/27), 88.89% (24/27), 85.19% (23/27), 74.07% (20/27), and 96.30% (26/27), respectively. Compared with pathological results, the total accuracy of N stage after transformation therapy that evaluated by MSCT was 62.96% (17/27), with the Kappa coefficient was 0.419 (P=0.003).ConclusionsMSCT has high accuracy and consistency for the N stage of advanced gastric cancer after transformation therapy. Besides, MSCT has a certain diagnostic rate for lymph node metastasis in patients with advanced gastric cancer in lymph node groups of No.1, No.3, No.5, No.6, No.7, No.8, and No.16.
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 recognize the latest research progress of immunotherapy for advanced gastric cancer (AGC). MethodThe domestic and international literature on immunotherapy for AGC in recent years were retrieved and reviewed. ResultsThe immunotherapy for AGC mainly focused on immune checkpoint inhibitors (ICIs), cellular immunity, and antitumor vaccines. The most immunotherapy researched was ICIs, especially for programmed death protein-1 / programmed death protein ligand 1, cytotoxic T lymphocyte associated antigen 4, and lymphocyte activating gene 3. The cellular immunotherapy and tumor vaccine therapy were less relatively. Although immunotherapy alone did not have a particularly good effect, its therapeutic effect was not inferior to that of chemotherapy alone and the incidence of adverse reactions was lower. Moreover, most studies had concluded that the use of immunotherapy in combination with other therapy had shown a good clinical efficacy, especially in combination with anti-human epidermal growth factor receptor 2 antibody, and chimeric antigen receptor T cells targeting Claudin 18.2 site had promising results in the AGC. ConclusionsWith the development of immunotherapy research, the strategies of immunotherapy for AGC are also constantly improving. Precision medicine is important in the process of immunotherapy. Targeted screening suitable patients and adopting precise treatment can further benefit the survival of patients with AGC.
ObjectiveTo understand the latest research progress in the treatment of advanced gastric cancer (AGC) and explore the optimal treatment strategy. Method The latest literature on the treatment of AGC was retrieved and reviewed. Results For patients with AGC, chemotherapy, radiotherapy, targeted therapy, immunotherapy, palliative therapy, nutritional support, and traditional Chinese medicine therapy were currently adopted in clinic, the combination of them were used usually. Some patients obtained good therapeutic effects by new chemotherapy drugs and antibody conjugated drugs. In the era of first-line immunotherapy or targeted therapy, first-line immunotherapy alone, immunotherapy in combination with chemotherapy, double immunotherapy, and immunotherapy combined with anti-angiogenesis targeted drugs for AGC had represented some survival benefits. ConclusionsThe research, development, and widespread application of new anti-tumor drugs have continuously expanded the treatment methods for AGC. The development of tumor molecular biology provides an opportunity for the treatment of AGC, and the precise diagnosis and treatment pattern guided by molecular typing is gradually maturing. However, the treatment of AGC is still facing challenges. In the era of precision medicine, facing the higher heterogeneity of gastric cancer, the dilemma of precise treatment of drugs for AGC, and the research and development of new anti-tumor drugs, the optimal treatment mode of AGC still needs more clinical exploration. It is necessary to comprehensively consider various aspects such as the patient’s physical condition, previous treatment status, and drug accessibility.