Li Wenke, Wei Jing, Zhang Pengfei, Cheng Mo, Xu Menghui, Zhu Lin, Liu Ming
Gastric Cancer Center/Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Integrated Traditional and Western Medicine, West China Hospital, Sichuan University, Chengdu, China.
Front Immunol. 2025 Jun 27;16:1625273. doi: 10.3389/fimmu.2025.1625273. eCollection 2025.
Hepatoid adenocarcinoma of the stomach (HAS) is a rare but highly aggressive subtype of gastric cancer (GC) associated with an unfavorable prognosis, particularly in advanced or metastatic stages. While the standard first-line treatment for advanced GC involves immune checkpoint inhibitors (ICIs) combined with chemotherapy, HAS often shows a poor therapeutic response to this regimen. The hypoxia in the tumor microenvironment is considered a key factor limiting ICI efficacy, and combining hyperbaric oxygen therapy (HBOT) with immunotherapy may offer a synergistic sensitizing effect.
We report a case of advanced HAS with peritoneal metastasis who received standard first-line immunochemotherapy (CAPOX plus sintilimab). After four cycles, the patient achieved only stable disease (SD) per RECIST 1.1 criteria. Consequently, HBOT was introduced as a sensitizing agent after the fifth cycle, and the patient subsequently completed the sixth cycle. This report was prepared using the CARE reporting guideline and checklist (Supplement A).
Following the addition of HBOT, the patient's tumor markers normalized. Subsequent imaging and endoscopic evaluations revealed a complete resolution of all lesions, meeting the criteria for a clinical complete response (cCR) under RECIST 1.1.
This case suggests that adding HBOT may enhance the efficacy of immunotherapy and overcome resistance to ICIs in advanced HAS. These promising findings warrant further investigation through prospective clinical studies to confirm this observation.
胃肝样腺癌（HAS）是一种罕见但侵袭性很强的胃癌（GC）亚型，预后不良，尤其是在晚期或转移阶段。虽然晚期GC的标准一线治疗包括免疫检查点抑制剂（ICIs）联合化疗，但HAS对该方案的治疗反应往往较差。肿瘤微环境中的缺氧被认为是限制ICI疗效的关键因素，将高压氧治疗（HBOT）与免疫疗法相结合可能会产生协同致敏作用。
我们报告一例晚期HAS伴腹膜转移患者，接受了标准一线免疫化疗（CAPOX加信迪利单抗）。四个周期后，根据RECIST 1.1标准，患者仅达到疾病稳定（SD）。因此，在第五个周期后引入HBOT作为致敏剂，患者随后完成了第六个周期。本报告是根据CARE报告指南和清单（补充A）编写的。
加入HBOT后，患者的肿瘤标志物恢复正常。随后的影像学和内镜评估显示所有病变完全消退，符合RECIST 1.1标准下的临床完全缓解（cCR）标准。
该病例表明，添加HBOT可能会增强免疫疗法的疗效，并克服晚期HAS对ICIs的耐药性。这些有前景的发现值得通过前瞻性临床研究进一步调查以证实这一观察结果。
