P-143 - Gastric cancer: system approach

Abstract

Introduction: Search of optimal diagnosis and treatment strategies for gastric cancer (GC) patients (GCP) (T1-4N0-2M0) realized. Methods: We analyzed data of 788 consecutive GCP (age=57±9.4 years; tumor size=5.4±3.1 cm) radically operated (R0) and monitored in 1975-2019 (m = 550, f = 238; distal gastrectomies=460, proximal gastrectomies=163, total gastrectomies=165, combined gastrectomies with resection of pancreas, liver, diaphragm, colon transversum, esophagus, duodenum, splenectomy, small intestine, kidney, adrenal gland=241; D2-lymphadenectomy=513, D3-4=275; T1=235, T2=219, T3=179, T4=155; N0=432, N1=108, N2=248; G1=222, G2=161, G3=405; early GC = 162, invasive=626; only surgery=620, adjuvant chemoimmunotherapy-AT=168 (5-FU + thymalin/taktivin). Multivariate Cox modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence. Results: Overall life span (LS) was 2136.6±2311.4 days and cumulative 5-year survival (5YS) reached 58.4%, 10 years – 52.3%, 20 years – 40.3%. 314 GCP lived more than 5 years (LS = 4323.2±2297.4 days), 171 GCP – more than 10 years (LS = 5855.4±2083.6 days). 286 GCP died because of GC (LS = 650.7±345.1 days). AT significantly improved 5YS (69% vs. 56.4%) (P = 0.0176 by log-rank test). Cox modeling displayed that 5YS of GCP significantly depended on: phase transition (PT) early—invasive GC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G, AT, procedure type, blood cell circuit, prothrombin index, hemorrhage time, residual nitrogen, ESS, gender (P = 0.000-0.046). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive GC (rank=1), PT N0—N12 (rank=2), healthy cells/CC (3); erythrocytes/CC (4), thrombocytes/CC (5), glucose (6), prothrombin index (7); monocytes/CC (8), lymphocytes/CC (9), eosinophils/CC (10), stick neutrophils/CC (11), segmented neutrophils/CC (12), leucocytes/CC (13). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0). Conclusion: Survival outcomes after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) GC characteristics; 9) procedure type; 10) anthropometric data. Optimal diagnosis and treatment strategies for GC are: 1) screening and early detection; 2) availability of experienced abdominal surgeons because of the complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunotherapy for GCP with unfavorable prognosis.