Study Of Efficacy And Influencing Factors Of Intraperitoneal Combined Systemic Application Of Paclitaxel And S-1 Apatinib Mesylate In Patients With Peritoneal Exfoliated Cytologically Positive Gastric Cancer

Objective:To investigate the efficacy and influencing factors of intraperitoneal combined systemic application of paclitaxel and S-1 apatinib mesylate in patients with peritoneal exfoliated cytologically positive gastric cancer.Methods:Clinical data of 48 patients with gastric cancer who were confirmed to be positive for peritoneal abscision cytology?P₀CY₁?were collected from 347 patients with gastric cancer who underwent laparoscopy combined with abscision cytology in the Fourth Hospital of Hebei Medical University.All 48 patients with P₀CY₁ gastric cancer were enrolled in prospective,single-center,phase II clinical trial?NCT03718624?,and were treated with intraperitoneal and systemic translational therapy of paclitaxel and S-1 apatinib mesylate after laparoscopy.After 3 cycles of translational therapy,48 patients with P₀CY₁ gastric cancer were re-examined by laparoscopy combined with peritoneal abscess cytology.Among them,the patients with abdominal free cancer cells turned negative underwent D2radical gastrectomy,and the original transformation treatment scheme was continued for 3 cycles after surgery.Among them,the patients who still had free cancer cells in the abdominal cavity or had visible metastasis to the naked eye continued to be treated with the original transformation therapy until the patient's disease progression,intolerance or death.With the successful transformation therapy of peritoneal free cancer cells into negative,the factors affecting the short-term efficacy of transformation therapy in patients with P₀CY₁ gastric cancer were discussed,and the effect of transformation therapy results on the prognosis of patients with P₀CY₁ gastric cancer was analyzed.Result:1.After 3 cycles of intraperitoneal and systemic treatment with paclitaxel and S-1 apatinib mesylate,16?33.333%?of the 48 patients with P₀CY₁ gastric cancer presented a large amount of ascites and gross metastases during the second laparoscopic exploration.The results of peritoneal abscission cytology were still positive in 11 cases?22.917%?.21 cases?43.750%?had negative transformation of abdominal free cancer cells.The success rate of conversion therapy was 43.750%in 21 patients and 27 patients.2.The single factor analysis results showed that P₀CY₁ conversion therapy in patients with gastric cancer in the near future curative effect and the sex of the patients?P=0.005?,tumor to begin with the longest diameter?P=0.044?,depth of tumor invasion?P=0.021?,number of lymph node metastasis?P=0.008?,CA19-9 expression situation to begin with?P=0.049?,tumor histological type?P=0.030?,tumor volume?P=0.045?related to begin with.3.Logistic multivariate regression analysis results showed that gender?P=0.018?,number of lymph node metastasis?P=0.023?,positive CA19-9expression at initial diagnosis?P=0.021?,and tumor volume at initial diagnosis?P=0.043?were independent factors influencing the short-term efficacy of conversion therapy in patients with P₀CY₁ gastric cancer.The survival time of P₀CY₁ patients with gastric cancer was more than 2 years in31 patients who received intraperitoneal combined with systemic paclitaxel and S-1 apatinib mesylate,and the 2-year overall survival rate was 64.583%.18 patients with successful conversion therapy survived for more than 2 years,and the 2-year overall survival rate was 85.714%.There were 13 patients who survived for more than 2 years after conversion therapy failure,and the 2-year overall survival rate was 48.148%.There was a significant difference in the2-year overall survival rate between patients who were successful in conversion therapy and those who were unsuccessful in conversion therapy?P=0.006?.Conclusion:1.Intraperitoneal combined with systemic application of paclitaxel and S-1 apatinib mesylate in the treatment of P₀CY₁ gastric cancer patients has a high conversion success rate,which can effectively prolong the survival time of patients.2.The prognosis of P₀CY₁ gastric cancer patients with successful translational therapy was significantly better than that of patients with failed translational therapy.3.Gender,tumor maximum diameter at initial diagnosis,tumor invasion depth,number of lymph node metastasis,CA19-9 expression at initial diagnosis,tumor histology type,and tumor volume at initial diagnosis were the influencing factors for the short-term efficacy of translational therapy in patients with P₀CY₁ gastric cancer.Gender,number of lymph node metastasis,positive CA19-9 expression at initial diagnosis,and tumor volume at initial diagnosis were independent influencing factors for the short-term efficacy of conversion therapy in patients with P₀CY₁ gastric cancer.