Study on the efficacy prediction analysis of neoadjuvant chemotherapy for locally advanced gastric cancer based on clinical characteristics and the screening of beneficial populations

LIU You-dong; CHEN Jie; LONG Zi-wen; LU Jun; LIU Xiao-wen; LIU Feng-lin

doi:10.19538/j.cjps.issn1005-2208.2025.04.10

Abstract：Objective To observe the clinical characteristics and therapeutic effects of neoadjuvant chemotherapy(NAC)for locally advanced gastric cancer,and to explore the potential beneficial population of NAC for gastric cancer.Methods Clinical data of patients with locally advanced gastric cancer after NAC undergoing D2 radical gastrectomy between June 2017 and December 2022 at Fudan University Shanghai Cancer Center were analyzed retrospectively.According to the postoperative pathological evaluation,they were divided into the NAC benefit group(n=157)and the non-benefit group(n=110).The clinical characteristics between the benefit group and the non-benefit group before and after NAC were compared and the logistic regression model was used to identify predictive factors for benefit group.Results There were statistically significant differences in cN stage,Lauren classification,signet ring cell carcinoma type,and serum expression of tumor marker CA19-9 and CA72-4(P＜0.05)between the two groups before NAC.The postoperative pathological examination results showed that there were also significant differences in tumor size,ypT and ypN stages,vascular invasion,and neural invasion(P＜0.05)between the two groups.The differences in overall survival time and relapse-free survival time between patients were also statistically significant,with longer survival time in the benefit group(P＜0.05).Multivariate analysis revealed that early cN stage(OR=0.087,95％CI 0.019-0.401,P=0.002),non-diffuse type(OR=0.625,95％CI 0.431-0.906,P=0.013),non-signet ring cell carcinoma(OR=3.178,95％CI 1.701-5.937,P＜0.001)were identified as independent predictors of the benefit of NAC in patients with locally advanced gastric cancer.Conclusion The characteristics of patients with locally advanced gastric cancer who benefit from NAC include early cN stage,non-diffuse type,non-signet ring cell carcinoma,low expression of serum tumor marker,small tumor diameter,and absence of vascular invasion and neural invasion.Early cN stage,non-diffuse type and non-signet ring cell carcinoma are independent predictive factors for the benefit of NAC in patients with locally advanced gastric cancer.Joint analysis of these factors contributes to timely adjust the comprehensive treatment strategy for patients with locally advanced gastric cancer.