Impact Of Blood Supply On Response And Survival In Advanced Gastric Cancer Patients Treated With Combination Of Intra-arterial And Intravenous Neoadjuvant Chemotherapy

AIM:We aimed to investigate the prognostic value of the tumor blood supply of patients with advanced gastric cancer treated with neoadjuvant chemotherapy.METHODS:We retrospectively reviewed 53 patients with advanced GC(?)who underwent neoadjuvant FLEEOX therapy for clinical stage ? tumors between January 2010 and August 2013 at the department of general surgery,Jinling hospital.As we all know,CT enhancement value can react tissue blood supply.In our study,we measured each tumor CT enhancement value(CT1)(CT1=arterial phase CT value-plain phase CT value;arterial phase CT value and plain phase CT value both are the average of five tumor CT value)before chemotherapy.In order to eliminate the individual differences,we used the same method to measure liver parenchyma CT enhancement value(CT2).The blood supply of tumor was defined as 'good' and 'poor' by the median value of CT1/CT2 counts.So,all patients were divided into good blood team(GBS)and poor blood supply team(PBS).The relationship among tumor blood supply and the response to chemotherapy,clinicopathologic characteristics,and overall survival was evaluated.RESULTS:The blood supply of tumor was strongly associated with the response to chemotherapy(p=0.039 by radiography and p=0.0351 by pathology,respectively,Fig1 A and B).The total efficiency in this study was 67.92%by radiography and 75.55%by pathology.However Patients with good blood supply have revealed an extremely high pRR(83.33%,90.91%)compared with(55.2%,60.87%)poor blood supply team.Overall survival(OS)at 3 years was 65.8%for the entire cohort.In univariate analysis,patients with good blood supply had a significantly superior OS(good blood supply vs poor blood supply:the 3-year OS 78.57%vs 54.44%;p=0.0245,respectively).What is more,macroscopic type of GC showed positive correlation with tumor blood supply.The blood supply of B4 is obvious better than B2,B3(B2vsB4 P<0.001,B3vsB4 P=0.041,Table 4).CONCLUSION:Advanced gastric cancer patients with good blood supply can obtain a chemotherapy benefit from neoadjuvant chemotherapy and may serve as a marker to identify patients who likely to benefit from neoadjuvant chemotherapy.