Abstract
BackgroundGastric cancer with only peritoneal lavage cytology (GC-CY1) is a special type of gastric cancer, which is defined as stage IV. The pre-treatment systemic immune-inflammation index (SII) and prognostic nutritional index (PNI) are representative blood indexes of systemic inflammatory response and nutritional status. However, the clinical significance of combined detection of these two indexes is still unclear. This study aims to evaluate the clinical value of the new score system by combining SII and PNI (SII-PNI score) as a predictor of efficacy and prognosis after neoadjuvant intraperitoneal and systemic (NIPS) paclitaxel combined with Apatinib conversion therapy for GC-CY1 patients.MethodsWe registered a prospective clinical study involving 36 GC-CY1 patients from April 2018 to August 2019 (NCT03718624). All patients underwent re-laparoscopic exploration after treatment. According to free cancer cells (FCCs) status, these patients were divided into FCCs group and non-FCCs group. The SII-PNI score ranged from 0 to 2 as follows: score of 2, high SII (≥512.1) and low PNI (≤52.9); score of 1, either high SII or low PNI; score of 0, no high SII nor low PNI.ResultsAll patients underwent re-laparoscopic exploration after 3 cycles of NIPS paclitaxel and Apatinib conversion therapy. Among them, 28 cases (77.78%) were in non-FCCs group, and 8 cases (22.22%) were in FCCs group. The SII-PNI score of non-FCCs patients was significantly lower than that of FCCs patients (p=0.041). The prognosis of patients with high SII-PNI score was significantly worse than that of patients with low SII-PNI score (p<0.001). Multivariate analysis showed that SII-PNI score was an independent prognostic factor for predicting overall survival and progression-free survival (p=0.001, 0.002).ConclusionPretreatment SII-PNI score is an important predictor for the efficacy of GC-CY1 patients after NIPS paclitaxel combined with Apatinib conversion therapy, which can help to identify high-risk groups and predict prognosis.
Highlights
Gastric cancer ranks fifth in morbidity and fourth in mortality worldwide [1]
We evaluated the predictive effect of pre-treatment systemic immuneinflammation index (SII)-prognostic nutritional index (PNI) score on efficacy and prognosis in GC-CY1 patients after neoadjuvant intraperitoneal and systemic (NIPS) paclitaxel combined with Apatinib conversion treatment to determine the optimal parameters for predicting survival and clinical response to this combined regimen
Patients were excluded if they presented with the following: (I) difficulty taking oral medications; (II) high blood pressure that could not be controlled by a single antihypertensive drug treatment; (III) 24 hour urine protein quantification >1.0 g; (IV) imaging results showing the tumor had invaded important blood vessels or the investigator judged that the tumor was highly likely to invade important blood vessels during treatment and cause fatal bleeding; (V) abnormal blood coagulation; and (VI) other comorbidities that may seriously endanger the safety of the patient or affect the completion of the study as determined by the investigator
Summary
Gastric cancer ranks fifth in morbidity and fourth in mortality worldwide [1]. Distant metastasis of gastric cancer mainly occurs through blood, lymphatic and direct invasion of adjacent organs [2]. The most common type of recurrence after treatment in advanced gastric cancer patients is peritoneal metastasis [3, 4]. Gastric cancer patients with only positive peritoneal lavage cytology (GC-CY1) is defined as the presence of free cancer cells in the abdominal cavity without peritoneal implantation or distant metastasis [5]. GC-CY1 is defined as stage IV in the 15th edition of the Japanese Classification of Gastric Cancer [6]. The eighth edition of the International Union Against Cancer (AJCC) TNM staging system considers GC-CY1 as an independent diagnostic criterion for distant metastasis(M1) [7]. Gastric cancer with only peritoneal lavage cytology (GC-CY1) is a special type of gastric cancer, which is defined as stage IV. This study aims to evaluate the clinical value of the new score system by combining SII and PNI (SII-PNI score) as a predictor of efficacy and prognosis after neoadjuvant intraperitoneal and systemic (NIPS) paclitaxel combined with Apatinib conversion therapy for GC-CY1 patients
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