Efficacy Of Apatinib In The Treatment Of Gastric Cancer Or Esophagogastric Junction Adenocarcinoma With Liver Metastases And Construction Of Nomogram

Part ? Efficacy of apatinib in the treatment of gastric cancer or esophagogastric junction adenocarcinoma with liver metastasesObjectives:To observe the clinical efficacy and safety of apatinib in the treatment of patients with gastric cancer and esophagogastric junction adenocarcinoma with liver metastases.Methods:68 patients with gastric cancer and esophagogastric junction adenocarcinoma with liver metastases were retrospective collection from March 2011 to December 2017 in the Third Affiliated Hospital of Suzhou University,including 46 cases of gastric cancer,esophagogastric junction 22 cases of adenocarcinoma.The oral dose of apatinib is 250-850 mg,and the dose adjustment is based on the adverse drug reaction and the physical state of the patient.The combination chemotherapy includes SOX,XELOX,single drug S-1 and transarterial chemoembolization(TACE).All patients underwent CT examination before and after treatment.and RECIST 1.1 was used to evaluate the early response of the tumor.NCI?CTCAE4.0 standard was used to evaluate adverse reactions,and the correlation between clinical pathological features and clinical efficacy was analyzed.The progression-free survival(PFS)and overall survival(OS)were followed up and the Cox regression model was used for multivariate survival analysis.RESULTS:Of the 68 patients,the median PFS were 3 month,the median OS were 5 month,early efficacy was evaluated according to RECIST 1.1 criteria,5 PR(7.35%),37 SD(54.41%),and 26 PD(38.24%).The ORR was 7.35%,and the DCR was 61.76%The initial doses of gender,age,primary site,gastrectomy,combination chemotherapy,and apatinib were not associated with early evaluation of RECIST 1.1 criteria(P>0.05);Univariate analysis showed that combined chemotherapy could prolong OS(HR=0.498,95%CI:0.279-0.891,P=0.019).Multivariate analysis showed that the combined chemotherapy group had a 46.6%lower risk of progression than the single-agent group(HR=0.534,95%CI:0.291?0.982,P=0.043),and the risk of death was reduced by 63.8%(HR=0.362,95%CI:0.187?0.700,P=0.003).Adverse reactions included leukopenia,anemia,thrombocytopenia,hand-foot syndrome,hypertension,fatigue and diarrhea,most of adverse reactions were in 1 or 2 grade,whose incidence was low and tolerance.Conclusion:Apatinib combined with chemotherapy in the treatment of gastric cancer and esophagogastric junction adenocarcinoma with liver metastasis patients with clinical efficacy,can significantly prolong the survival of this part of patients.Part ? Prognostic nomogram integrated systemic inflammation score for patients with gastric cancer undergoing RO resectionObjectives:Accumulating evidence has suggested the crucial role of inflammation in carcinogenesis and tumor progression.Additionally,nomogram combined with the biomarkers of systemic inflammation response(SIR)are able to predict more accurately compared to traditional staging systems.Herein,the study was designed to establish a widely accepted prognostic nomogram for gastric cancer(GC)on the basis of clinic?pathological characteristics and inflammation?based prognostic scores.Methods:Between January 2010 and December 2016,clinic-pathological data from 370 cases of newly diagnosed gastric adenocarcinoma patients who underwent RO surgical resection at the Third Affiliated Hospital of Soochow University were analyzed retrospectively.For nomogram construction and validation,all enrolled subjects were assigned to the training cohort(n=370),one third of whom were assigned to the validation cohort(n=101).These factors included gender,age,tumor length,degree of differentiation,location,retrieved lymph nodes,TNM stage,chemotherapy,type of gastrectomy,NLR,MLR,CRP/Alb and GPS.All variables with P<0.05 in univariate analyses were further included in multivariate Cox's proportional hazards model,based on which,the nomogram was established.Concordance index(C?index)and calibration curve were employed to assess the predictive accuracy and discriminative capacity of the nomogram,followed by comparison with the 7th and 8th AJCC TNM staging system.Tumor length,T stage,N stage,M stage,monocyte lymphocyte ratio(MLR)as well as Glasgow Prognostic Score(GPS)were integrated in the nomogram.Results:The C?index of the nomogram in the primary set(0.83)was higher than that in the 7th(0.78)and 8th editions TNM staging systems(0.80).Highly consistent outcomes between the nomogram and actual observation were presented by calibration curve in training and validation cohorts.The time?dependent receiver operating characteristics(ROC)curve demonstrated higher sensitivity as well as specificity for 3?and 5-year OS prediction in both cohorts.Conclusions:The proposed nomogram was a useful tool for the prognostic prediction in subjects with GC undergoing RO resection.