P-258 5-Year survival of gastric cancer patients after radical surgery was significantly depended on tumor characteristics, blood cell circuit, cell ratio factors, hemostasis system and adjuvant treatment

Abstract

Introduction: This study aimed to determine homeostasis and tumor factors for 5-year survival (5YS) of gastric cancer (GC) patients (GCP) (T1-4N0-2M0) after complete en block (R0) gastrectomies and D2-4 lymph node dissections. Methods: We analyzed data of 715 consecutive GCP (age = 57.1 ± 9.6 years; tumor size-D = 5.6 ± 3.1 cm) radically operated (R0) and monitored in 1975-2015 (m = 488, f = 227; total gastrectomy = 145, distal gastrectomy = 420, proximal gastrectomy = 150, combined gastrectomy with resection of 1-6 adjacent organs (pancreas, liver, diaphragm, colon transversum, splenectomy, small intestine, kidney, adrenal gland, etc.) = 232; T1 = 196, T2 = 203, T3 = 167, T4 = 149; M1 = 0; N0 = 376, N1 = 100, N2 = 239; G1 = 199, G2 = 132, G3 = 384; early GC = 125, invasive GC = 590; only surgery-S = 569, adjuvant treatment-AT = 146 (chemoimmunotherapy: 5-FU + thymalin/taktivin). Survival curves were estimated by the Kaplan-Meier method. Differences in curves between groups of GCP were evaluated using a log-rank test. Cox modeling, clustering, SEPATH, Monte Carlo, bootstrap simulation and neural networks computing were used to determine any significant dependence. Results: For total of 715 GCP overall life span (LS) was 2060.6 ± 2267.7 days, (median = 1022 days) and cumulative 5-year survival (5YS) reached 55.1%, 10 years – 48.7%, 20 years – 37.6%. 272 GCP lived more than 5 years without GC progressing, 149 – 10 years, 35 - 20 years. 281 GCP died because of GC during the first 5 years after surgery. 5YS was superior significantly after AT (69.8%) compared with S (52.4%) (P = 0.002 by log-rank test). Cox modeling displayed that 5YS significantly depended on: phase transition (PT) early-invasive GC in term of synergetics, PT N0-N12, G, blood cell circuit, cell ratio factors (CRF) (ratio between cancer cells and blood cells subpopulations), sex, AT, residual nitrogen, hemorrhage time, prothrombin index, procedure type (P = 0.000-0.048). Neural networks computing, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive GC (rank = 1), PT N0-N12 (rank = 2), D (3), erythrocytes/cancer cells-CC (4), AT (5), healthy cells/CC (6), prothrombin index (7), thrombocytes/cancer cells (8), monocytes/CC (9), stick neutrophils/CC (10), eosinophils/CC (11), leucocytes/CC (12), segmented neutrophils/CC (13), lymphocytes/CC (14). Correct prediction of 5YS was 100% by neural networks computing. Conclusion: 5YS of GCP after radical surgery was significantly depended on tumor characteristics, blood cell circuit, CRF, hemostasis system and AT.