Abstract:
Objective To investigate the clinical characteristics and survival prognosis of patients with advanced gastric cancer who develop acute upper gastrointestinal bleeding (AUGB) during neoadjuvant chemotherapy.
Methods A retrospective analysis of 476 patients with gastric cancer who received preoperative neoadjuvant chemotherapy between January 2015 and January 2017 at The Fourth Hospital of Hebei Medical University was performed.Patients who developed AUGB during neoadjuvant therapy were screened, and the clinical characteristics and factors affecting prognosis were analyzed.
Results Thirty-five (7.35%) of the 476 patients with gastric cancer developed AUGB during neoadjuvant chemotherapy.Bleeding was conservatively managed in 6 cases by rehydration hemostasis. Bleeding was successfully stopped in 5 cases via endoscopy and in 7 cases by interventional angiography and embolization.Bleeding was stopped in the remaining 17 patients by performing exploratory laparotomy.The 3-year overall survival (OS) rate in the whole group of patients was 65.13%, and the 3-year disease-free survival (DFS) rate was 60.71%.The 3-year OS rate in patients who developed AUGB was 48.57%, and the 3-year DFS rate in this group was 42.86%.In patients without AUGB, the 3-year OS and DFS rates were 66.44% and 62.13%, respectively.The differences in the 3-year OS and DFS rates between the two groups were significant (P= 0.033 and P=0.025, respectively).Multivariate analysis using a Cox proportional hazard model revealed that poorly differentiated/undifferentiated histology (P=0.004 and P=0.008, respectively), cTNM stage Ⅲ(P=0.002 and P=0.013, respectively), and failure to continue chemotherapy after the occurrence of AUGB (P=0.003 and P=0.005, respectively) were independent factors affecting the prognosis of patients and the recurrence of AUGB.
Conclusions The occurrence of AUGB during neoadjuvant chemotherapy in advanced gastric cancer patients is related to a variety of risk factors, and clinical attention should be paid to such patients.At the same time, AUGB occurring during neoadjuvant chemotherapy requires active hemostatic treatment, and the continuation of chemotherapy after successful hemostasis may prolong the survival of such patients.