Efficacy of Neoadjuvant Chemotherapy in Elderly Patients with Lo-cally Advanced Gastric Cancer and Influencing Factors of Prognosis
[Objective]To assess the efficacy of neoadjuvant chemotherapy in elderly patients with locally ad-vanced gastric cancer,and the factors influencing the prognosis of patients.[Methods]Clinical and pathological data of 154 patients aged ≥70 years with locally advanced gastric cancer who underwent preoperative neoad-juvant chemotherapy and radical gastrectomy in Zhejiang Cancer Hospital from January 2012 to December 2022 were retrospectively analyzed.The efficacy of neoadjuvant chemotherapy was assessed and the factors influencing the prognosis of patients were analyzed.[Results]In this cohort,90.3％of patients completed two or more cycles of neoadjuvant chemotherapy.The incidence of Grade 3～4 adverse events was 17.5％.The pathological complete response and major pathological response rates are 7.8％and 32.5％,respectively.The R0 resection rate was 97.4％,and the incidence of Clavien-Dindo Grade Ⅱ～Ⅲ postoperative complications was 12.3％.The 1-year,3-year,and 5-year overall survival were 84.4％,53.2％and 44.3％,respectively.There was significant difference in overall survival between the neoadjuvant chemotherapy response group(TRG1a or TRG1b)and the non-response group(TRG2 or TRG3)(P＜0.001).Additionally,patients with less metastatic lymph nodes and a higher postoperative prognostic nutritional index demonstrated a better overall prognosis.Multivariate Cox regression analysis revealed that tumor size ≥ 5 cm,preoperative CEA level＞5 ng/mL and presence of vascular cancer thrombus were independent risk factors of poorer prognosis of patients.[Conclusion]For elderly patients with locally advanced gastric cancer,neoadjuvant chemotherapy can effec-tively reduce tumor burden and improve the prognosis of those who respond well to neoadjuvant chemotherapy with manageable safety.
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