Postoperative Clinical Features,Survival,and Prognosis Analysis Of Primary Gastric Lymphoepithelioma-like Carcinoma

Bckground and purpose:Primary lymphoepitheliomatoid carcinoma of the stomach is a rare pathological type of gastric cancer.Its incidence rate is low,accounting for 1-7% of gastric cancer.At present,many studies have analyzed its clinicopathological characteristics and prognosis,but there is no unified consensus on its treatment scheme,and the efficacy analysis of different adjuvant chemotherapy schemes has not been reported.The aim of this study is to retrospectively evaluate the clinical and pathological characteristics of patients with gastric lymphoepithelial tumor like carcinoma,explore the survival outcomes of gastric lymphoepithelial tumor like carcinoma with or without adjuvant chemotherapy,and evaluate the efficacy of different adjuvant chemotherapy regimens in patients with gastric lymphoepithelial tumor like carcinoma,and analyze the factors that affect their prognosis.Method:Retrospective collection of clinical and pathological data,adjuvant chemotherapy regimens,and survival outcomes of patients with primary gastric lymphoepithelial tumor like carcinoma who underwent surgical resection at the First Affiliated Hospital of Nanchang University from January 2012 to December 2021,based on the Natrius criteria.The main evaluation indicators included disease-free survival(DFS)and overall survival(OS).Use the Kaplan Meier method to plot the patient survival curve.The use of COX regression for univariate and multivariate survival analysis showed statistically significant p-values of<0.05.Result:A total of 63 patients were included,with a median age of 62 years,male patients were the majority(90.5%),and 96.8% of patients were positive for EBV encoded small RNA(EBER),the tumor site was more common in the gastric body(41 cases,65.1%),and the pathological staging was mainly stage II(28 cases,44.4%)and stage III(19 cases,30.2%).Patients were divided into two groups based on the use of adjuvant chemotherapy regimen(28 cases in the non adjuvant chemotherapy group and 35 cases in the adjuvant chemotherapy group).There were statistical differences in T staging(P=0.049),N staging(P=0.001),tumor staging(P=0.001),nerve invasion(P=0.023),CA125(P=0.024),and PD-L1(P=0.014)between the two groups of patients;The survival analysis results showed that there was no statistically significant difference in the 2-year DFS rate(91.7% vs.84.4%)and 2-year OS rate(95.2% vs.94.0%)between the non adjuvant chemotherapy group and the adjuvant chemotherapy group,there was no statistically significant difference in DFS and OS between the two groups of patients(p=0.198,p=0.423);Further analysis was conducted on the differences in survival time among stage II,III,II/III,and I/II/III patients with or without adjuvant chemotherapy,and no statistical differences were found in survival time(p=0.407,p=0.949,p=0.631,p=0.760).Subsequently,the DFS and OS of stage I/II and stage III/IV patients were analyzed,as well as the impact of the presence or absence of vascular cancer thrombi on DFS.The results showed that there was no statistically significant difference in DFS and OS between stage I/II and stage III/IV patients(p=0.128,p=0.210);Patients with no tumor thrombi in the vascular system have better DFS compared to those with visible tumor thrombi in the vascular system(p=0.038).No statistically significant prognostic factors affecting DFS were observed in both univariate and multivariate models,nor were any prognostic factors affecting OS observed.Among the 35 patients who received adjuvant chemotherapy,23 were based on platinum chemotherapy drugs and 9 were based on paclitaxel chemotherapy drugs.Comparing patients who received platinum chemotherapy drugs and paclitaxel chemotherapy drugs,survival analysis did not find any statistical differences in DFS and OS between the two groups of patients(p=0.189,p=0.134);The 2-year DFS rates of the two groups of patients were 89.8%and 75.0%,respectively,with no statistically significant difference(p>0.10).The2-year OS rates were 87.5% and 88.9%,respectively,with no statistically significant difference(p>0.50).Both univariate and multivariate analyses did not identify prognostic factors affecting DFS and OS in adjuvant chemotherapy patients.Conclusion:GLELC has unique clinical and pathological characteristics: it is commonly seen in middle-aged,elderly,and male patients;The tumor is mostly located at the proximal end;Stages II and III are more common;Low lymph node metastasis rate;In the overall population,there was no statistical difference in survival analysis between the group with and without the use of adjuvant chemotherapy.Patients without tumor thrombi in the vascular system had better DFS compared to those with visible tumor thrombi in the vascular system.No prognostic factors affecting DFS and OS were observed in the prognosis analysis;In the adjuvant chemotherapy population,there was no statistical difference in the effects of adjuvant chemotherapy regimen on DFS and OS,and no prognostic factors affecting DFS and OS were observed in adjuvant chemotherapy patients.