Background: Neoadjuvant chemotherapy is an important part of the comprehensive treatment of advanced gastric cancer (GC). The effect of neoadjuvant chemotherapy plays a key role in the prognosis of GC patients. Pathological response can represent the effect of neoadjuvant chemotherapy. However, evidence focused on pathological response and associated clinicopathological factors in GC patients is quite little. In this retrospective study, the clinicopathological factors affecting the effect of neoadjuvant chemotherapy in GC patients were investigated, and suggestions were proposed to improve the effect of neoadjuvant chemotherapy on GC.
Methods: Retrospective analysis was performed on GC patients who received radical surgery after neoadjuvant chemotherapy from February 2016 to March 2019 at Peking Union Medical College Hospital. Relevant clinicopathological data was collected to analyze the factors influencing the effect of neoadjuvant chemotherapy. Chi-square test was used for univariate analysis. Logistic regression was used for multivariate analysis. Receiver operating characteristic curve (ROC) was used to determine the cut-off value of variables which significantly influenced the effect of neoadjuvant chemotherapy.
Results: A total of 171 GC patients were included in the study. Analyses showed that patients <60 years old (OR=1.971[1.032-3.764], P=0.040), pathological type of poor differentiation or signet ring cell carcinoma (OR=2.449[1.172-5.119], P=0.017), and weight loss during neoadjuvant chemotherapy (OR=2.091[1.090-4.011], P=0.027) were independent risk factors for neoadjuvant chemotherapy effect. In ROC analysis of weight change and neoadjuvant chemotherapy effect, area under the curve (AUC) was 0.591(P=0.046) and cut-off value of weight change was -2.9%. Chi-square test showed patients without weight loss during neoadjuvant chemotherapy had a higher rate of oral nutritional supplement (ONS) than patients with weight loss (P=0.046).
Conclusions: Patients <60 years old, pathological type of poor differentiation or signet ring cell carcinoma, and weight loss during neoadjuvant chemotherapy were independent risk factors for neoadjuvant chemotherapy effect in GC patients. Patients with weight loss >2.9% during neoadjuvant may have a worse chemotherapy effect. Timely nutritional support such as ONS to maintain patients’ body weight is crucial for improving the effect of neoadjuvant chemotherapy.