The Clinical Significance Of Serum Smad4 And CTC Levels In The Treatment And Prognosis Of Locally Advanced/Advanced Gastric Cancer

Background: Gastric cancer is the fifth largest cancer in the world,with nearly 1.09 million new cases of gastric cancer worldwide in 2020.Gastric cancer is the fourth leading cause of cancer death,with nearly 770,000 deaths worldwide in 2020.China is a high incidence area of gastric cancer in the world,and the mortality rate is high.The morbidity and mortality rate rank third in malignant tumors.The detection of Smad4 and CTC has the effect of evaluating the curative effect and evaluating the prognosis,which has been confirmed in various cancers such as colon cancer,breast cancer and lung cancer.The significance of the combination of the two indicators is more reliable than that of a single indicator.This article briefly studies the clinical significance of changes in serum Smad4 and CTC levels in the treatment efficacy and prognosis of gastric cancer,and provides a reference for evaluating efficacy and predicting prognosis.Objective: In this study,the levels of Smad4 and CTC before and after treatment of locally advanced / advanced gastric cancer were dynamically observed to evaluate the efficacy and prognosis.Methods: According to the inclusion criteria,60 patients with locally advanced / advanced gastric cancer(gastroesophageal junction cancer)confirmed by histopathological or cytological examination and related imaging examination who were treated in the First Hospital of Qinhuangdao and the Fourth Affiliated Hospital of Hebei Medical University from September 2020 to September 2022 were selected.They were randomly divided into experimental group(n=30)and control group(n=30).The treatment regimen was as follows : Sindilimab combined with SOX regimen :Sindilimab 200 mg ivgtt d0 q3 w;oxaliplatin 130 mg / m2 ivgtt d1;gio 40-60 mg bid po d1-14 q3 w.Control group 30 cases,treatment : SOX regimen :oxaliplatin 130 mg / m2 ivgtt d1;gio 40-60 mg bid po d1-14 q3 w.Objective Response Rate(ORR),Disease Control Rate(DCR),Progression-free Survival(PFS)and other indicators were used to study the clinical significance of serum Smad4 and CTC levels in the treatment and prognosis of locally advanced / advanced gastric cancer.The data were processed by SPSS25.0,and the measurement data were expressed as(x±s).The t-test was used within the group,The chi-square test was used to compare the count data between groups.P<0.05 was considered statistically significant.The factors affecting PFS were analyzed by Cox proportional hazard regression model.P<0.05 was considered statistically significant.Results:1.Among the 30 patients in the experimental group,the efficacy was evaluated as CR 2 cases,PR 17 cases,SD 9 cases,PD 2 cases,ORR 63.3 %,DCR 93 %;among the 30 patients in the control group,CR 1 case,PR 8 cases,SD 13 cases,PD 8 cases,ORR 30 %,DCR 73.0 %;through chi-square test analysis,the treatment effect(ORR,DCR)of the experimental group was significantly better than that of the control group(P<0.05).2.In the experimental group,28 patients had no progression,and the mean values of Smad4 three measurements(ng/m L)were : 17.38 ± 3.89,21.34± 3.46,25.30 ± 4.85.The levels within the group(P<0.05)were statistically significant.The mean values of CTC three measurements were: 16.21 ±3.10,11.25 ± 2.89,6.50 ± 2.73;the average value of Smad4 three measurement results(ng/m L)was: 18.76 ± 2.57,19.49 ± 5.09,22.36 ± 4.84.The mean values of CTC three measurements were 15.50 ± 2.60,12.18 ± 2.52 and 8.27 ± 2.59.After treatment,the serum Smad4 level in the two groups showed a positive correlation trend(P<0.05),and the CTC level showed a negative correlation trend with the outcome(P<0.05).After treatment,the serum Smad4 and CTC levels in the experimental group were more obvious than those in the control group(P<0.05).3.After 3 cycles of treatment,the levels of Smad4 and CTC after 6 cycles of treatment were correlated with tumor prognosis(P<0.05).Conclusions:1.The dynamic monitoring of peripheral blood Smad4 and CTC levels can be used as a therapeutic evaluation index for locally advanced / advanced gastric cancer;2.The dynamic changes of Smad4 and CTC levels have more advantages in the evaluation of curative effect than the control group in the regimen of immunotherapy combined with chemotherapy;3.The dynamic changes of Smad4 and CTC levels can be used as prognostic indicators for locally advanced / advanced gastric cancer.