Outcomes of transarterial chemoembolization in neoadjuvant therapy of patients with gastric cancer: A multicenter retrospective cohort study.

Abstract

410 Background: Gastric cancer is one of the most common cancers globally. About half of new cases were reported in China, and the most cases are advanced gastric cancer. According to treatment guideline, gastric cancers with pT3-4, any N or any pT, N+ are recommended to fluoropyrimidine based preoperative/neoadjuvant chemotherapy, followed by D2 resection and adjuvant chemotherapy, however, the five-years survival rate remain only 30%~50%. Methods: We had a multi-center retrospective cohort study about outcome of 43 gastric cancers with pT3-4, any N treated by Transarterial Chemoembolizaion (TACE) in neoadjuvant chemotherapy between October 2018 and June 2019. The procedure of TACE is that nutrition artery of tumor, usually left, right or right gastroomental artery, was injected into Oxaliplatin (130mg/m2) in DSA, follow by 2ml Iodized Oil Granules. After TACE, patients had S1 from D1 to D14, cycled every 21 days. And then, patients had another above-mentioned TACE+oral S1 procedure, followed by a systemic chemotherapy regimen SOX (Oxaliplatin was injected through vein). After that, a D2 resection (If tumor can be resected) was given to the patients. 3 cycles adjuvant chemotherapy (SOX regimen) were given to patients after operation. Results: 42/43 (97.7%) patients have D2 resection successfully, and 1/42 patient went to systemic chemotherapy because liver metastasis was found before second TACE treatment. According to pathological analysis about the tumor tissues after resection, TRG (Tumor response grade) 0 was 25 in 42 (59.5%); TRG 1 was 10 (23.8%); TRG 2 was 5 (11.9%) and TRG 3 was 2 (4.8%). Anastomotic leak was reported in 3/42 (7.14%); abdominal infection anastomotic leak was in 4/42 (9.5%); no bleeding was reported. All patients were recovered after symptomatic treatment. No death was reported because of the short-term complications. 3-years PFS was 64.2% (95% CI: 60-69), 5 patients had local recurrence, 7 patients had distant recurrence and 3 patients had both. 3-years OS was 71.4% (95% CI: 65-75). Conclusions: TACE used in neoadjuvant therapy of patients with gastric cancer was safe, and shown as a promising method for improving the survival prognosis.