Correlation Between Inflammation And Nutrition-related Indicators And First-line Chemotherapy For Advanced Gastric Cancer

Background:Gastric cancer?GC?is one of the most common malignant tumors in the world.According to the WHO report 2018,the number of gastric cancer accounts for5.7%of all new cancer cases?about 1 million?,and its incidence rate is fifth.The death toll accounts for 8.2%of cancer-related deaths?about 783 thousand?,ranking the third in cancer mortality after lung cancer and colon cancer^[1].Although surgical treatment was an important means for patients with gastric cancer to get a cure,due to the hidden early symptoms of gastric cancer and rapid progress,a considerable number of patients have lost the opportunity to operate when they are diagnosed.Even after the D2 radical operation of gastric cancer,a considerable number of patients still have relapse and metastasis.Systemic chemotherapy is still an important treatment for these two types of patients,but the current chemotherapy has reached in the bottleneck period,how to predict the short-term and long-term curative effect of gastric cancer patients and guide the treatment strategy is an urgent problem to be solved.Objective:To explore the relationship between inflammation and nutrition related indexes and the chemotherapy effect and prognosis of first-line chemotherapy for advanced gastric cancer,so as to select the best independent predictor of response effect and prognosis,and to provide new ideas for clinical workers in the selection of treatment plan,treatment effect and prognosis of advanced gastric cancer.Methods:Patients with advanced gastric cancer from January 2013 to October 2018were collected from the Second Affiliated Hospital of Dalian Medical University.All patients were diagnosed by pathology.All data were statistically processed by SPSS26.0 software.?²test or Fisher exact test were used to determine the relationship between the clinical characteristics,inflammation,nutritional indicators and the short-term efficacy of the patients.Using Logistic regression model to find independent predictors of chemotherapy efficacy.Kaplan-Meier method was used to calculate the OS and PFS of patients.Log-rank test was used to compare the groups.COX regression method was used to determine the risk factors affecting the prognosis.All results were statistically significant P<0.05.Result:1.?²test or Fisher's exact test were used to analyze the clinical characteristics of 210 patients with advanced gastric cancer before chemotherapy and the relationship between the inflammation and nutrition indexes and ORR,DCR.The results showed that the ORR of the group with increased CEA level was higher than that of the normal group?P<0.05?;The ORR of the group with initial stage IV was higher than that of the group with relapse and metastasis?P<0.05?;The ORR and DCR of the group with multiple drugs were higher than that of the group with single drugs?P<0.05?.However,inflammation and nutritional indexes were not related to ORR and DCR?P>0.05?.2.?²test or Fisher exact test were used to analyze the relationship between the changes of inflammation and nutrition indexes and ORR,DCR in 210 patients with advanced gastric cancer before and after chemotherapy.The results showed that the changes of SIRI before and after chemotherapy were negatively correlated with ORR?P<0.05?,the changes of SIRI and SII before and after chemotherapy were negatively correlated with DCR?P<0.05?,and the changes of PA before and after chemotherapy were positively correlated with DCR?P<0.05?.3.Logistic regression model was used to analyze the influencing factors of ORR and DCR in patients with advanced gastric cancer.The results showed that:single drug/multi drug,the change of SIRI before and after chemotherapy,the change of PA before and after chemotherapy can be used as the predictor of DCR in chemotherapy.Patients with multi drug chemotherapy,the decrease of SIRI after chemotherapy,and the increase of PA level after chemotherapy had better disease control rate?P<0.05?,and no predictor of ORR was found?P>0.05?.4.?1?The survival curve was drawn by Kaplan-Meier method,and Log-Rank test was used to analyze the clinical characteristics of 210 patients with advanced gastric cancer before chemotherapy and the relationship between inflammation,nutrition index and PFS,OS.The results showed that:whether relapse,the level of SIRI before chemotherapy were related to PFS?P<0.05?.COX regression analysis showed that whether relapse was an independent prognostic factor of PFS in patients with advanced gastric cancer during the first-line chemotherapy?P<0.05?.?2?Whether relapse or not,the level of SIRI,PLR and PA before chemotherapy were correlated with OS?P<0.05?.COX regression analysis showed that:whether relapse and PA before chemotherapy were the prognostic factors of OS in patients with advanced gastric cancer?P<0.05?.5.?1?Kaplan-Meier method was used to draw the survival curve,and the relationship between the changes of inflammation and nutrition indexes and PFS,OS in210 patients with advanced gastric cancer before and after chemotherapy was analyzed by Log-rank test.The results showed that the median PFS in the PA group increased after chemotherapy was higher than that in the group decreased after chemotherapy?P<0.05?,but there was no statistical significance in the COX multivariate regression analysis?P>0.05?.?2?There was no correlation between the changes of inflammation and nutrition indexes and OS before and after chemotherapy?P>0.05?.Conclusion:1.Patients with multi drug chemotherapy,decreased SIRI and increased PA after chemotherapy have better disease control rate.2.Postoperative recurrence and metastasis of advanced gastric cancer patients have better PFS,OS than the initial stage IV patients.3.PA before chemotherapy was an independent prognostic factor for OS in patients with advanced gastric cancer.