Efficacy Of Systemic Chemotherapy Combined With Hyperthermic Intraperitoneal Chemotherapy In Neoadjuvant Chemotherapy And Transformation Therapy For Advanced Gastric Cancer

Objective: To analyze the clinical efficacy of systemic chemotherapy combined with intraperitoneal hyperthermic perfusion chemotherapy in neoadjuvant chemotherapy and translational therapy for locally invasive stage III gastric cancer and distant metastatic stage IV gastric cancer.Study methods: This study retrospectively analyzed the clinical data of 177 patients with gastric cancer who received systemic chemotherapy combined with intraperitoneal hyperthermic perfusion chemotherapy from June 2010 to December 2020.All patients were given oxaliplatin + tegafur + intraperitoneal hyperthermic perfusion chemotherapy regimen.After chemotherapy,the patients were divided into two groups according to whether surgery or not,including 83 cases in the surgery group and 94 cases in the non-surgery group.The general characteristics of the two groups were compared and analyzed by chisquare test.Survival time was performed using the Kaplan-Meier method,and log-rank analysis was performed to compare survival rates.Cox regression was used to find factors in the variables considered for independent prognosis.Results:（1）Of the 177 patients,73 responded to chemotherapy,and the overall response rate of chemotherapy was 41.2%.A total of 81（45.7%）patients experienced chemotherapy toxicity.There was a significant statistical difference in the efficacy of chemotherapy between patients in the surgery group and patients in the non-surgery group（P = 0.001）.（Fig.2）,68（81.9%）of the 83 patients in the surgical group underwent R0 resection（including 29 distal gastrectomy,37 total gastrectomy,and 2 proximal gastrectomy,including 3 combined organ resections）.（Fig.3）,the survival of 83 patients in the surgical group was 35 months,which was higher than 13 months of 94 patients in the non-surgical group（P < 0.001）.（Fig.4）,univariate Cox survival analysis showed that N stage,R0 resection and unresectable factors were the main factors affecting the prognosis of patients.Multivariate Cox survival analysis showed that N stage and R0 resection were independent prognostic factors.Conclusion: For patients with unresectable gastric cancer,systemic chemotherapy combined with intraperitoneal hyperthermic perfusion chemotherapy can improve the R0 resection rate and effectively prolong the survival time.Serious adverse reactions occurred during chemotherapy,and the toxic reactions were controllable.N stage and R0 resection factors after translational therapy were related to the survival of patients.