Comprehensive treatment focusing on transarterial chemoembolization for postoperative liver metastasis in gastric cancer patients

Abstract

Objective: To investigate the clinical efficacy of comprehensive treatment focusing on transarterial chemoembolization (TACE) for postoperative liver metastasis in patients with gastric cancer and analyze the factors influencing prognosis.

Methods: A retrospective study was conducted on 116 patients who developed liver metastasis after gastric cancer surgery and were admitted to Gansu Provincial Cancer Hospital between January 2018 and February 2020. The observation group, consisting of 62 patients, received TACE with fluorouracil (FU) + irinotecan (CPT-11) + oxaliplatin (OXA) and moderate lipiodol embolization. The control group, consisting of 54 patients, received systemic S-1 and Oxaliplatin regimen (SOX) alone. The clinical efficacy and incidence of adverse reactions were compared between the two groups. Liver function indicators, tumor markers, and immunoglobulin changes were analyzed in both groups. The 2-year survival rate of patients was analyzed using the Kaplan-Meier (K-M) curve. Lasso-Cox regression was used to identify independent prognostic factors affecting the 2-year survival rate. A Nomogram model was constructed to predict outcomes.

Results: The overall clinical efficacy (P = 0.001) and objective response rate (ORR) (P = 0.001) were significantly lower in the control group compared to the observation group. No significant differences were found in ALT and AST changes between the two groups (P > 0.05). Post-treatment, CEA and CA19-9 levels were significantly lower, and IgG and IgM levels were significantly higher in the observation group (P < 0.001). There was no significant difference in the incidence of adverse reactions (P > 0.05). Lasso-Cox regression identified treatment plan, pathological differentiation, degree of liver metastasis, and pre-treatment CEA as independent prognostic factors for 2-year survival. Based on these, a Nomogram model was constructed. In the training group, the model had AUC values over 0.8 for 1- and 2-year survival rates, and in the validation group, the AUC was 0.765 and 0.687, respectively, indicating good predictive performance.

Conclusion: Compared to the conventional SOX regimen, comprehensive treatment focusing on TACE embolization for postoperative liver metastasis in gastric cancer is more effective and can improve survival rates.

Keywords: Transarterial chemoembolization (TACE); gastric cancer; liver metastasis; prognosis.

Figure 1

Study flowchart.

Figure 2

Changes in liver function indicators before and after treatment. A. Comparison of ALT levels before and after treatment in both groups. B. Comparison of AST levels before and after treatment in both groups. Note: ALT, Alanine Transaminase; AST, Aspartate Transaminase.

Figure 3

Changes in tumor markers before and after treatment. A. Comparison of CEA levels before and after treatment in both groups. B. Comparison of CA19-9 levels before and after treatment in both groups. Note: CEA, Carcinoembryonic Antigen; CA19-9, Carbohydrate Antigen 19-9.

Figure 4

Changes in immunoglobulin levels before and after treatment. A. Comparison of IgG levels before and after treatment in both groups. B. Comparison of IgA levels before and after treatment in both groups. C. Comparison of IgM levels before and after treatment in both groups. Note: IgG, Immunoglobulin G; IgA, Immunoglobulin A; IgM, Immunoglobulin M.

Figure 5

Survival curves for the 17 factors. Note: ECOG PS, Eastern Cooperative Oncology Group Performance Status; ALT, Alanine Transaminase; AST, Aspartate Transaminase; CEA, Carcinoembryonic Antigen; CA19-9, Carbohydrate Antigen 19-9; IgG, Immunoglobulin G; IgA, Immunoglobulin A; IgM, Immunoglobulin M.

Figure 6

Lasso-cox regression screening for prognostic factors in GCLM. A. Regularization path of the Lasso model. B. Selection of Lasso feature coefficients. Note: GCLM, Gastric Cancer with Liver Metastasis.

Figure 7

Construction and validation of the nomogram model. A. Nomogram model constructed using the four prognostic variables. B. Time-dependent ROC curves, calibration curves, and DCA curves in the training group. C. Time-dependent ROC curves, calibration curves, and DCA curves in the validation group. Note: CEA, Carcinoembryonic Antigen; ROC curve, Receiver Operating Characteristic; DCA, Decision Curve Analysis.