Study On Analysis Of Clinicopathological Features And Prognostic Factors Of Metastatic Or Recurrent Gastric Cancer

ObjectiveTo investigate the relationship between nutrition,inflammation,tumor markers and clinicopathological features of metastatic or recurrent gastric cancer(MRGC)and the predictive value of prognosis of patients with MRGC;to summarize the characteristics of traditional Chinese medicine(TCM)syndrome and the rule of TCM medication in MRGC,and to preliminarily evaluate the effect of TCM evidence-based treatment on the prognosis of MRGC.MethodsAccording to the inclusion and exclusion criteria,we retrospectively analyzed the clinical data of 120 patients with MRGC who were pathologically confirmed in the First Affiliated Hospital of Guangzhou University of Chinese Medicine on January 1,2014 to January 1,2019.The factors analyzed in the study included:(1)Basic data: gender,age,height,weight;(2)Clinicopathological data: tumor site,pathological type,degree of tissue differentiation,neurovascular infiltration;(3)Characteristics of recurrence and metastasis: type of recurrent metastasis,presence of liver metastasis and ascites;(4)Index parameters: inflammatory factors: Neutrophil-to-lymphocyte Ratio(NLR),Platelet-to-lymphocyte Ratio(PLR);nutritional indicators:Prognostic Nutritional Index(PNI),body mass index(BMI);tumor markers:CEA,CA125,CA19-9,CA15-3,AFP;(5)TCM syndrome differentiation,TCM medication and follow-up regular treatment time of TCM decoction;(6)Time: time of death,time of last follow-up,and calculation of actual survival time.Statistical analysis was performed using SPSS24.0,and chi-square test was used to investigate the relationship between nutritional index,inflammation and tumor markers and clinicopathological variables of MRGC.The median overall survival time(m OS)of patients was counted using Kaplan-Meier method,and the main factors affecting the prognosis of MRGC survival were explored using univariate survival analysis and COX Proportional hazard regression model.Results1.PNI(<49)was associated with age(P =0.003),neurovascular infiltration(P =0.001),liver metastasis(P =0.001),and ascites(P =0.009)in MRGC patients.NLR(≥3)was associated with peritoneal recurrence and metastasis(P =0.000).PLR(≥160)was correlated with peritoneal recurrence and metastasis(P =0.002)and tissue differentiation(P = 0.006).CEA(≥5 ng/m L)was correlated with age(P= 0.006),neurovascular invasion(P= 0.042),and liver metastases(P=0.000).CA125(≥35 U/m L)and CA15-3(≥25 U/m L)were associated with peritoneal recurrence and metastasis(P =0.000;P =0.038).CA199(≥27 U/m L)was associated with distant metastasis(P=0.010).There was no significant difference between BMI and AFP in clinicopathological features of MRGC.2.The mean survival time after recurrence and metastasis in MRGC patients was 12.272±0.943 months,with a median survival time of9.000±0.529 months,1-year survival rate of 31% and 2-year survival rate of 15.4%.Univariate analysis showed that Lauren’s classification(P=0.006),neurovascular invasion(P=0.000),liver metastasis(P =0.000),CEA(P =0.000),and PNI(P =0.007)were associated with MRGC prognosis,and multivariate analysis showed that Lauren’s staging(P=0.002),neurovascular invasion(P =0.020),and CEA(P =0.023)were independent factors of MRGC prognosis.3.The distribution of TCM syndromes in MRGC patients were: phlegm-damp coagulation syndrome(21.6%),liver-stomach discordance syndrome(16.7%),Stasis toxin internal resistance syndrome(11.7%),qi and blood deficiency syndrome(24.2%),qi and yin deficiency syndrome(17.5%),and spleen and kidney yang deficiency syndrome(8.3%).Based on the association rules and cluster analysis of Chinese herbal medicines,the basic prescriptions for the treatment of MRGC were obtained: Tangerine Peel,Pinellia,Poria,Codonopsis,Atractylodes,Amomum,and Coix Seed,among which the strongest association is Poria-Atractylodes.4.TCM syndrome and duration of TCM intervention were not related to the overall prognostic survival of MRGC,with the best prognosis for the liver-stomach discordance syndrome and the worst prognosis for the qi and blood deficiency syndrome.The m OS of MRGG patients with TCM intervention for more than 3 months is 9 months and less than 3 months is 8 months.Conclusion1.The decrease of PNI and the increase of CEA were associated with advanced age,neurovascular infiltration and liver metastasis in MRGC patients.The levels of NLR,PLR,CA125 and CA15-3 were associated with peritoneal metastasis.The increase of CA19-9 was associated with distant metastasis.2.Lauren’s classification,neurovascular invasion,liver metastasis,CEA,and PNI were associated with prognosis of MRGC patients.Neurovascular invasion and CEA were independent prognostic risk factors,and intestinal Lauren type was independent prognostic protective factors.3.MRGC is a disease with deficiency syndrome and combination of deficiency and excess syndrome,and the common syndrome are qi and blood deficiency,and phlegm-damp coagulation.The basic prescriptions for the treatment of MRGC is Er Chen Decoction and Ginseng Bai Zhu Decoction,and TCM intervention can improve the prognosis of patients to some extent.