ObjectiveTo summarize controversy and progress of multi-slice spiral CT in efficacy evaluation of transformation therapy for advanced gastric cancer.MethodThe recent studies published at home and abroad on the spiral CT in evaluating the therapeutic effect of transformation therapy for the advanced gastric cancer were reviewed and analyzed.ResultsIn recent years, though the energy spectrum and dual-energy CT examinations had appeared, the most common tool in evaluating of the efficacy of transformation therapy for the advanced gastric cancer was the spiral CT. The most common evaluation standard was still the RECIST standard.ConclusionsSpiral CT has its outstanding diagnostic significance in therapeutic evaluation of transformation therapy for advanced gastric cancer. Although there is some controversy, with advancements of a large number of studies, it will greatly help diagnosis and treatment of advanced gastric cancer.
ObjectiveTo explore the value of multi-slice spiral CT (MSCT) in the judgment of N stage and lymph node metastasis of patients with advanced gastric cancer who underwent surgery after transformation therapy.MethodsClinical data of 27 patients with advanced gastric cancer who underwent surgery after transformation therapy, form July 2017 to July 2019 in Affiliated Yantai Yuhuangding Hospital of Qingdao University were analyzed retrospectively, and all of patients underwent SOX regimen transformation therapy. The MSCT enhanced scan was performed before operation, and the postoperative pathology was used as the gold standard. The preoperative N stage and lymph node metastasis groups were evaluated by MSCT enhanced scan and compared with the pathological results.Results Before the operation, MSCT was used to evaluate the lymph node metastasis of the patients with advanced gastric cancer after transformation therapy, and compared with the lymph nodes metastasis of the corresponding pathological results, the accuracy rates of lymph node groups in No.1, No.3, No.5, No.6, No.7, No.8, and No.16 were 77.78% (21/27), 81.48% (22/27), 85.19% (23/27), 88.89% (24/27), 85.19% (23/27), 74.07% (20/27), and 96.30% (26/27), respectively. Compared with pathological results, the total accuracy of N stage after transformation therapy that evaluated by MSCT was 62.96% (17/27), with the Kappa coefficient was 0.419 (P=0.003).ConclusionsMSCT has high accuracy and consistency for the N stage of advanced gastric cancer after transformation therapy. Besides, MSCT has a certain diagnostic rate for lymph node metastasis in patients with advanced gastric cancer in lymph node groups of No.1, No.3, No.5, No.6, No.7, No.8, and No.16.
ObjectiveTo explore the value of multi-slice spiral CT (MSCT) in ycT stage and ycN stage evaluation of patients with locally advanced gastric cancer (cT4bN0-3M0) who underwent surgery after transformation therapy.MethodsClinical data of 32 patients with locally advanced gastric cancer (cT4bN0-3M0) in Affiliated Yantai Yuhuangding Hospital of Qingdao University form January 2017 to April 2019 were retrospective analyzed. All the patients underwent surgery after SOX regimen transformation therapy. Preoperative MSCT plain and enhanced scan were used to evaluate clinical T stage (ycT) and clinical N stage (ycN). The accuracy of MSCT scanning was evaluated by comparing with the gold standard for postoperative pathological ypT stage and ypN stage.ResultsThe accuracy of preoperative MSCT examination on ycT stage after transformation therapy was 78.1% (25/32), and that of ycN was 56.3% (18/32).ConclusionThe accuracy of MSCT in preoperative ycT stage and ycN stage after successful transformation therapy for locally advanced gastric cancer (cT4bN0-3M0) is relatively high.
Objective To evaluate the preliminary efficacy and safety of XELOX combined with trastuzumab in the transformation therapy of human epidermal growth factor receptor 2 (HER2) positive elderly patients with advanced gastric cancer. Methods The clinical and surgical data of 21 patients with HER2 positive elderly patients with advanced gastric cancer who were treated with XELOX combined with trastuzumab in our Hospital from February 2019 to February 2021 were retrospectively analyzed, and the remission of patients after conversion therapy and the relevant indicators during and after surgery were observed. Results After the conversion therapy, there were 2 cases (9.5%) of complete remission, 13 cases (61.9%) of partial remission, and 6 cases (28.6%) of stable disease, the remission rate of the conversion therapy was 71.4% (15/21). After conversion treatment, 21 patients underwent laparoscopic exploration, of which 20 patients (95.2%) underwent R0 resection, simple exploration 1 case. In all 21 cases, the operative time was 124–185 min, with a median of 152 min. The intraoperative blood loss was 100–210 mL, with a median of 120 mL. The number of lymph nodes cleared was 12–54, with a median of 32. The duration of indwelling gastrointestinal decompression was 51–134 h, with a median of 102 h. The recovery time of gastrointestinal function was 70–98 h, with a median of 78 h. The drainage time in the abdominal operation area was 4–9 days, with a median of 6 days. Postoperative hospital stay was 7–13 days, with a median of 8 days. There were 2 cases of Grade IIIA complications (1 case of incomplete intestinal obstruction and 1 case of pulmonary infection) and 2 cases of Grade II complications (1 case of incision fat liquefaction and 1 case of jugular catheter infection) after operation. All patients were followed up for 3–36 months, with a median of 16.8 months. The median progression-free survival time was 12.4 months and the median overall survival time was 20.5 months. Conclusion For HER2 positive elderly patients with advanced gastric cancer, XELOX combined with trastuzumab transformation therapy is effective and safe.