Abstract: The efficacy of neoadjuvant versus adjuvant chemotherapy for Borrmann type Ⅳ gastric cancer: A propensity score matching analysis        YU Peng-fei*, HUANG Xing-mao, XIA Yu-hang, et al. *Department of Gastric Surgery, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou 310022, China
Corresponding author：CHENG Xiang-dong, E-mail：abdsurg@163.com
YU Peng-fei and HUANG Xing-mao contributed equally to the article
Abstract    Objective    To explore the clinical efficacy of neoadjuvant chemotherapy in patients with Borrmann type Ⅳ gastric cancer and the main factors affecting the prognosis of these patients.Methods    The data of patients with Borrmann type Ⅳ gastric cancer admitted to the Department of Gastric Surgery of Zhejiang Cancer Hospital from July 2010 to July 2020 were retrospectively analyzed.According to different treatment regimens，the patients were divided into the neoadjuvant chemotherapy group（NCT group）and the non-neoadjuvant chemotherapy group（NNCT group），and the effects of different treatment regimens on the prognosis of these patients were compared after propensity score matching. Results    After propensity score matching，a total of 254 patients were enrolled，including 90 patients in the NCT group and 164 patients in the NNCT group.Neoadjuvant chemotherapy and postoperative adjuvant chemotherapy were based on oxaliplatin combined with S-1.The R0 resection rate of the NCT group and NNCT group were 90.0% and 87.8%，respectively，with no statistically significant difference（P=0.599）.The 3-year survival rates of the NCT group and the NNCT group were 33.3% and 29.3%（P=0.623），and the 5-year survival rates were 25.6% and 25.0%（P=0.713）.There was no significant difference in overall survival between the two groups.For patients with and without R0 resection，the 3-year survival rates were 33.3% and 10.3%（P＜0.01），and the 5-year survival rates were 28.4% and 0（P＜0.01）.A total of 40 patients（15.7%）in the two groups received hyperthermic intraperitoneal chemotherapy（HIPEC）.The 3-year survival rates of the HIPEC group and non-HIPEC group were 55.0% and 26.2%（P=0.012），and the 5-year survival rates were 45.0% and 21.5%（P=0.028）.The survival rate of HIPEC group was significantly better than that of non-HIPEC group. Conclusion  Borrmann type Ⅳ gastric cancer is poorly differentiated and has a high incidence of peritoneal metastasis.Neoadjuvant chemotherapy based on platinum combined with S-1 failed to improve the R0 resection rate and survival of patients with Borrmann type Ⅳ gastric cancer.Combined with intraperitoneal local therapy such as HIPEC may improve the prognosis of these patients.

Key words: gastric cancer, Borrmann type Ⅳ, neoadjuvant chemotherapy, surgery, prognosis 

摘要： 目的    探索新辅助化疗对Borrmann Ⅳ型胃癌病人的临床疗效及影响此类病人预后的主要因素。方法  回顾性分析浙江省肿瘤医院胃外科2010年7月至2020年7月收治的Borrmann Ⅳ型胃癌病人资料，根据不同的治疗方案，分为新辅助治疗组（NCT组）和非新辅助治疗组（NNCT组），通过倾向性得分匹配后，比较不同治疗方案对此类病人预后的影响。结果    通过倾向性得分匹配后，共入组254例病人，其中NCT组90例，NNCT组164例，新辅助化疗及术后辅助化疗均采用奥沙利铂联合替吉奥的方案。NCT组和NNCT组R0切除率分别为90.0%和87.8%，差异无统计学意义（P=0.599）。NCT组和NNCT组的3年生存率分别为33.3%和29.3%（P=0.623），5年生存率分别为25.6%和25.0%（P=0.713），两组总体生存率差异无统计学意义。获得R0切除与非R0切除病人的3年生存率分别为33.3%和10.3%（P＜0.01），5年生存率分别为28.4%和0（P＜0.01）；两组共有40例病人（15.7%）接受了腹腔热灌注化疗（HIPEC），HIPEC治疗组和未行HIPEC治疗组病人的3年生存率分别为55.0%和26.2%（P=0.012），5年生存率分别为45.0%和21.5%（P=0.028），HIPEC治疗组预后好于非HIPEC治疗组，且差异具有统计学意义。结论    Borrmann Ⅳ型胃癌分化差，腹膜转移发生率高。以铂类联合氟尿嘧啶类为基础的新辅助化疗未能有效提高Borrmann Ⅳ型胃癌病人的R0切除率及生存率，而联合腹腔局部治疗如HIPEC可能有望改善此类病人的预后。

关键词: 胃癌, Borrmann Ⅳ型, 新辅助化疗, 手术治疗, 预后