| Objective:To explore the relationship between common inflammatory indexes,nutritional indexes,coagulation indexes and efficacy of neoadjuvant chemotherapy for gastric cancer and prognosis of signet ring gastric cancer,and to find out the predictive factors of efficacy of neoadjuvant chemotherapy for gastric cancer and prognosis of signet ring gastric cancer.Methods:1.According to the inclusion and exclusion criteria,208gastric cancer patients receiving neoadjuvant chemotherapy more than one cycle before operation in Xiangya Hospital were selected as the research objects.The clinical demographic data,tumor pathological characteristics,inflammation indexes,coagulation indexes and nutritional indexes before the first neoadjuvant chemotherapy of the above patients were retrospectively summarized.The tumor regression grade(TRG)was used to determine the response to neoadjuvant chemotherapy.Logistic multivariate regression analysis was used to determine the independent predictors of the response to neoadjuvant chemotherapy.2.According to the inclusion and exclusion criteria,212 patients with signet ring gastric cancer who underwent radical gastrectomy in gastrointestinal surgery of Xiangya Hospital were selected as the study subjects.The clinical demographic data,tumor pathological features,preoperative inflammation indexes,coagulation indexes and nutritional indexes of the above patients were retrospectively summarized.5-year OS was taken as the end point of the study,Kaplan-Meier survival analysis was used to compare the difference in survival rates,and Cox proportional hazard regression model was used for multivariate analysis to determine the independent prediction index of the prognosis of signet ring gastric cancer.Results:1.Univariate analysis showed that chemotherapy regimen(χ~2=14.227;P=0.007),ALB(t=-2.628;P=0.009),AGR(t=-3.244;P=0.001),PNI(t=-2.102;P=0.037),TT(Z=-2.909;P=0.004),D-dimer(Z=-2.760;P=0.006)and signet ring gastric cancer(χ~2=21.398;P<0.001)were significantly correlated with NAC therapeutic effect;2.Multivariate analysis showed that compared with paclitaxel-based regimens,oxaliplatin and fluorouracil based regimens had better NAC efficacy(OR:0.395,95%CI:0.176-0.887),non-signet-ring gastric cancer had better NAC efficacy(OR:5.498,95%CI:2.205-13.710),D-dimer before first chemotherapy(OR:3.730,95%CI:1.466-9.491)and TT before first chemotherapy(OR:0.216,95%CI:0.093-0.500)were independent predictors of NAC efficacy;3.Univariate analysis showed the depth of tumor invasion(χ~2=49.726;P<0.001),lymph node metastasis(χ~2=30.269;P<0.001),p TNM stage(χ~2=49.322;P<0.001),surgical approach(χ~2=8.489;P=0.004),age(t=-2.213;P<0.028),CEA(Z=-3.265;P=0.001),PLR(Z=-2.196;P=0.028),LMR(Z=-2.226;P=0.026),ALB(t=3.284;P=0.001),PNI(t=-3.789;P<0.001)and FIB(Z=-3.065;P=0.002)were significantly correlated with the survival status of patients;4.Multivariate analysis showed that age(HR:0.563,95%CI:0.363-0.873),tumor invasion depth(HR:0.226,95%CI:0.098-0.520),p TNM stage(HR:0.444,95%CI:0.255-0.771),preoperative CEA level(HR:0.597,95%CI:0.386-8.790),and preoperative LMR level(HR:1.776,95%CI:1.150-2.741)were independent prognostic factors for patients with signet ring gastric cancer.Conclusion:1.High levels of D-dimer and short TT before NAC are independent predictors of poor NAC efficacy in gastric cancer;2.Low preoperative LMR level indicates poor prognosis in signet ring gastric cancer patients,the risk of death in low preoperative LMR group is 1.776 times higher than that in high preoperative LMR group. |
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