经导管动脉化疗栓塞联合静脉化疗作为局部 进展期胃癌新辅助治疗的有效性和安全性研究

Efficacy and Safety of Transcatheter Arterial Chemoembolization Combined with Intravenous Chemotherapy as Neoadjuvant Therapy for Locally Advanced Gastric Cancer: A Clinical Study

摘要: 本研究旨在评估经导管动脉化疗栓塞(TACE)联合静脉化疗作为局部进展期胃癌新辅助治疗的有效性和安全性。方法：回顾性分析2022年3月至2024年7月接受新辅助治疗的106例LAGC (Locally Advanced Gastric Cancer)患者的临床资料。患者术前行2次TACE + 1次静脉化疗，用药为奥沙利铂(130 mg/m²)加/不加nab-paclitaxel (150 mg/m²)，并口服3周替吉奥。主要观察指标为病理完全缓解(pCR)率，次要观察指标为客观缓解率(ORR)、生存期和安全性。结果：接受经导管动脉化疗栓塞(TACE)联合静脉化疗患者106例，92患者接受了手术，R0切除率为97.8%。101例患者(9例因疾病进展无法行根治手术)中，42例(41.6%)取得pCR，客观缓解率为71.3%，T降期69例(75%)，N降期57例(62%)。15例(16.3%)患者术后出现复发转移，与非pCR相比，获得pCR的患者表现出更好的无事件生存期(EFS)、无病生存期(DFS)和总生存期(OS)。主要≥3级治疗相关不良事件(TRAEs)为贫血(7.6%)、恶心呕吐(9.4%)、食欲下降(9.4%)，无患者死于TRAE。鲍曼分型、肿瘤位置、有无印戒癌以及肿瘤直径因素影响着pCR及预后情况。结论：经导管动脉化疗栓塞(TACE)联合静脉化疗在局部进展期胃癌中显示出良好的新辅助疗效和可管理的安全性。

Abstract: This study aimed to evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with intravenous chemotherapy as neoadjuvant therapy for locally advanced gastric cancer (LAGC). Methods: A retrospective analysis was conducted on the clinical data of 106 patients with LAGC who received neoadjuvant therapy from March 2022 to July 2024. Patients underwent two TACE sessions and one intravenous chemotherapy session before surgery, with the chemotherapy regimen consisting of oxaliplatin (130 mg/m²) plus or minus nab-paclitaxel (150 mg/m²), and oral tegafur for three weeks. The primary outcome was the pathological complete response (pCR) rate, while the secondary outcomes were the objective response rate (ORR), survival, and safety. Results: A total of 106 patients received TACE combined with intravenous chemotherapy, and 92 patients underwent surgery, with an R0 resection rate of 97.8%. Among the 101 patients (9 patients could not undergo radical surgery due to disease progression), 42 (41.6%) achieved pCR, the objective response rate was 71.3%, tumor downstaging was observed in 69 cases (75%) for T and 57 cases (62%) for N. Postoperative recurrence and metastasis occurred in 15 patients (16.3%). Compared with non-pCR patients, those achieving pCR showed better event-free survival (EFS), disease-free survival (DFS), and overall survival (OS). The main grade ≥ 3 treatment-related adverse events (TRAEs) were anemia (7.6%), nausea and vomiting (9.4%), and decreased appetite (9.4%), and no patient died from TRAEs. Borrmann classification, tumor location, presence or absence of signet ring cell carcinoma, and tumor diameter affected pCR and prognosis. Conclusion: Transcatheter arterial chemoembolization (TACE) combined with intravenous chemotherapy demonstrated favorable neoadjuvant efficacy and manageable safety in locally advanced gastric cancer.