Combined intra-arterial and intravenous chemotherapy for unresectable, advanced gastric cancer has an improved curative effect compared with intravenous chemotherapy only

Wang,Jinfeng; Shi,Huacun; Yang,Guang; Han,Guangjie; Zhao,Man; Duan,Xiaoling; Mi,Lili; Han,Xin; Li,Ning; Shi,Jianfei; Yin,Xiaolei; Yin,Fei

doi:10.3892/ol.2018.8068

Combined intra-arterial and intravenous chemotherapy for unresectable, advanced gastric cancer has an improved curative effect compared with intravenous chemotherapy only

Authors:
- Jinfeng Wang
- Huacun Shi
- Guang Yang
- Guangjie Han
- Man Zhao
- Xiaoling Duan
- Lili Mi
- Xin Han
- Ning Li
- Jianfei Shi
- Xiaolei Yin
- Fei Yin
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Affiliations: Department of Gastroenterology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050035, P.R. China, Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050035, P.R. China
Published online on: February 16, 2018 https://doi.org/10.3892/ol.2018.8068
Pages: 5662-5670
Copyright: © Wang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The aim of the present study was to evaluate the efficacy and safety of a combination of intra‑arterial and intravenous chemotherapy in the treatment of unresectable, advanced gastric cancer, and assess which patients are likely to benefit from combined treatment. The clinical data of 128 patients diagnosed with unresectable, advanced gastric cancer at The Fourth Hospital of Hebei Medical University (Shijiazhuang, China) from January 2009 to September 2012 were retrospectively analyzed. The patients were divided into two groups as follows: Those who received regional intra-arterial chemoembolization plus systemic chemotherapy (combined group; n=62) and those who received systemic chemotherapy only (venous group; n=66). The clinical response, overall survival (OS) and toxic effects in the two groups were compared. Univariate and multivariate analyses were performed to identify the primary factors affecting the survival time of patients in the combined group. The overall response rate was significantly increased (35.5%) in the combined group compared with the venous group (19.7%; P=0.045). The median OS was 14 months in the combined group and 13 months in the venous group, and the 1‑year and 2‑year survival rates in the two groups were 45.2 and 9.7%, and 40.9 and 6.1%, respectively. There were significant differences between the survival curves (P=0.044). The median time to progression in the combined group and the venous group was 10 months and 6 months, respectively, and the difference was statistically significant (P=0.003). Multivariate analysis revealed that tumor‑node‑metastasis (TNM)‑stage and the degree of tumor staining were independent factors affecting OS. No differences in adverse reactions between the two groups were observed (P>0.05). The combination of intra‑arterial and intravenous chemotherapy may effectively improve the rate of clinical response, prolong OS and time to symptomatic progression in patients with unresectable, advanced gastric cancer, in particular those with an earlier TNM stage and distinct tumor staining.

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1	Hamilton JP and Meltzer SJ: A Review of the Genomics of Gastric Cancer. Clin Gastroenterol Hepatol. 4:416–425. 2006. View Article : Google Scholar : PubMed/NCBI
2	Crew KD and Neugut AI: Epidemiology of gastric cancer. World J Gastroenterol. 12:354–362. 2006. View Article : Google Scholar : PubMed/NCBI
3	Zhu XD and Li J: Gastric carcinoma in China: Current status and future perspectives (Review). Oncol Lett. 1:407–412. 2010. View Article : Google Scholar : PubMed/NCBI
4	Zhang CW, Zou SC, Shi D and Zhao DJ: Clinical significance of preoperative regional intra-arterial infusion chemotherapy for advanced gastric cancer. World J Gastroenterol. 10:3070–3072. 2004. View Article : Google Scholar : PubMed/NCBI
5	Li M, Zhang J, Wang D, Zhong B, Tucker S, Lu S, Cheng J, Cao C, Xu J and Pan H: A phase II study of intra-arterial chemotherapy of 5-fluorouracil, cisplatin, and mitomycin C for advanced nonresectable gastric cancer. Anticancer Drugs. 20:941–945. 2009. View Article : Google Scholar : PubMed/NCBI
6	Shchepotin IB, Cborny V, Hanfelt J and Evans SR: Palliative superselective intra-arterial chemotherapy for advanced nonresectable gastric cancer. J Gastrointest Surg. 3:426–431. 1999. View Article : Google Scholar : PubMed/NCBI
7	Edge SB and Compton CC: The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 6:1471–4. 2010. View Article : Google Scholar
8	Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET and Carbone PP: Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 5:649–655. 1982. View Article : Google Scholar : PubMed/NCBI
9	Seldinger SI: Catheter replacement of the needle in percutaneous arteriography; a new technique. Acta Radiol. 39:368–376. 1953. View Article : Google Scholar : PubMed/NCBI
10	Miller AB, Hoogstraten B, Staguet M and Winkler A: Reporting results of cancer treatment. Cancer. 47:207–214. 1981. View Article : Google Scholar : PubMed/NCBI
11	Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, et al: New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1). Cancer. 45:228–247. 2009.
12	Zhang C, Li G, Fan C, Xu J, Cao J, Liu S and Li N: Comparison of efficacy of different route of administration of chemotherapy on unresectable, advanced gastric cancer. World J Surg Oncol. 10:1622012. View Article : Google Scholar : PubMed/NCBI
13	Nakajima T, Ishihara S, Motohashi H, Kitamura Y, Nakajima Y, Fujii M, Tokunaga A, Matai K, Anzai H and Nishi M: Neo-Adjuvant chemotherapy for inoperable gastric cancer via local and general delivery routes (FLEP Therapy)Cancer Treatment An Update. Springer; Paris Germany: pp. 411–413. 1994, View Article : Google Scholar
14	Shi DH, Cao JM, Gao DZ, Xu J, Kong WD, Li CL and Wang ZQ: Modified FOLFOX regimen combined with interventional therapy for the treatment of advanced gastric cancer: A clinical study. Intervent Radiol. 18:759–762. 2009.
15	Zhu ZD and Pu YD: The study of pharmacokinetics of 5-Fu after left gastric artery intra-arterial infusion in treatment of gastric carcinoma. Chin J Bases Clin General Surg. 8:26–28. 2001.
16	Tao HQ and Zou SC: Effect of preoperative regional artery chemotherapy on proliferation and apoptosis of gastric carcinoma cells. World J Gastroenterol. 8:451–454. 2002. View Article : Google Scholar : PubMed/NCBI
17	Zou SC and Tao HQ: Several questions related on preoperative regional arterial chemotherapy for gastric and colorectal cancer. World Chin J Digest. 15:477–481. 2007.
18	Gu X, Gao XS, Cui M, Xie M, Peng C, Bai Y, Guo W, Han L, Gu X and Xiong W: Clinicopathological and prognostic significance of platelet to lymphocyte ratio in patients with gastric cancer. Oncotarget. 7:49878–49887. 2016. View Article : Google Scholar : PubMed/NCBI
19	Cho IR, Park JC, Park CH, Jo JH, Lee HJ, Kim S, Shim CN, Lee H, Shin SK, Lee SK and Lee YC: Pre-treatment neutrophil to lymphocyte ratio as a prognostic marker to predict chemotherapeutic response and survival outcomes in metastatic advanced gastric cancer. Gastric Cancer. 17:703–710. 2014. View Article : Google Scholar : PubMed/NCBI
20	Yamanaka T, Matsumoto S, Teramukai S, Ishiwata R, Nagai Y and Fukushima M: The baseline ratio of neutrophils to lymphocytes is associated with patient prognosis in advanced gastric cancer. Oncology. 73:215–220. 2007. View Article : Google Scholar : PubMed/NCBI
21	Lee S, Oh SY, Kim SH, Lee JH, Kim MC, Kim KH and Kim HJ: Prognostic significance of neutmphil lymphocyte ratio and platelet lymphocyte ratio in advanced gastric cancer patients treated with FOLFOX chemotherapy. BMC Cancer. 13:3502013. View Article : Google Scholar : PubMed/NCBI
22	Wang SC, Chou JF, Strong VE, Brennan MF, Capanu M and Coit DG: Pre-treatment neutrophil to lymphocyte ratio independently predicts disease specific survival in resectable GE junction and gastric adenocarcinoma. Ann Surg. 263:292–297. 2016. View Article : Google Scholar : PubMed/NCBI
23	Bald T, Quast T, Landsberg J, Rogava M, Glodde N, Lopez-Ramos D, Kohlmeyer J, Riesenberg S, van den Boorn-Konijnenberg D, Hömig-Hölzel C, et al: Ultraviolet-radiation-induced inflammation promotes angiotropism and metastasis in melanoma. Nature. 507:109–113. 2014. View Article : Google Scholar : PubMed/NCBI
24	Wada Y, Yoshida K, Tsutani Y, Shigematsu H, Oeda M, Sanada Y, Suzuki T, Mizuiri H, Hamai Y, Tanabe K, et al: Neutrophil elastase induces cell proliferation and migration by the release of TGF-α, PDGF and VEGF in esophageal cell lines. Oncol Rep. 17:161–167. 2007.PubMed/NCBI
25	Tian N and Zhang PT: Relationship between neutrophilia and cancer progress or metastasis. Chin Canc. 19:470–476. 2010.
26	Schreiber RD, Old LJ and Smyth MJ: Cancer immunoediting: integrating immunity's roles in cancer suppression and promotion. Science. 331:1565–1570. 2011. View Article : Google Scholar : PubMed/NCBI
27	Smyth MJ, Dunn GP and Schreiber RD: Cancer immunosurveillance and immunoediting: The roles of immunity in suppressing tumor development and shaping tumor immunogenicity. Adv Immunol. 90:1–50. 2006. View Article : Google Scholar : PubMed/NCBI
28	Ray-Coquard I, Cropet C, Van Glabbeke M, Sebban C, Le Cesne A, Judson I, Tredan O, Verweij J, Biron P, Labidi I, et al: Lymphopenia as a Prognostic Factor for Overall Survival in Advanced Carcinomas, Sarcomas, and Lymphomas. Cancer Res. 69:5383–5391. 2009. View Article : Google Scholar : PubMed/NCBI
29	Morris M, Platell C and Iacopetta B: Tumor-infiltrating lymphocytes and perforation in colon cancer predict positive response to 5-fluorouracil chemotherapy. Clin Cancer Res. 14:1413–1417. 2008. View Article : Google Scholar : PubMed/NCBI