Duan Tingwang, Ma Dan, Bai Zhaoqin, Ding Xiaolong, Zhang Xinhua
Department of Gastroenterology, Lanzhou First People's Hospital No. 1 Wujiayuan West Street, Qilihe District, Lanzhou 730050, Gansu, China.
First School of Clinical Medicine, Gansu University of Chinese Medicine No. 35 Dingxi East Road, Chengguan District, Lanzhou 730000, Gansu, China.
Am J Transl Res. 2025 Aug 15;17(8):6068-6079. doi: 10.62347/FFQN8329. eCollection 2025.
To compare the efficacy and safety of TPF versus FOLFOX regimens in conversion therapy for locally unresectable advanced gastric cancer (LAUGC) and to identify prognostic factors influencing clinical outcomes.
This retrospective study analyzed 264 LAUGC patients treated with either TPF (n=140) or FOLFOX (n=124) between 2019 and 2021. Primary endpoints were objective response rate (ORR) and 1-year survival; secondary endpoints included conversion surgery rate, toxicity, and 3-year survival. Prognostic factors were evaluated using multivariate Cox regression and time-dependent ROC analyses.
The TPF group demonstrated significantly higher ORR (P=0.01) and disease control rate (DCR; P<0.001) compared to the FOLFOX group. Rates of conversion surgery (P=0.011) and R0 resection (P=0.003) were also improved. One-year survival was superior in the TPF cohort (P<0.05), whereas 3-year survival rates showed no significant difference (P>0.05). Although myelosuppression was more frequent with TPF (P=0.002), the incidence of severe adverse events was comparable between groups. Multivariate analysis identified FOLFOX regimen, elevated carcinoembryonic antigen (CEA), and N3 stage as risk factors for 1-year mortality, while higher albumin levels and lymphocyte counts were protective. Tumor size ≥5 cm and poor differentiation were associated with increased 3-year mortality risk. Albumin demonstrated strong predictive value for 1-year survival.
The TPF regimen can effectively improve the objective response rate and short-term survival in LAUGC patients undergoing conversion therapy, with manageable myelosuppression. The analysis of prognostic risk factors facilitates individualized treatment strategies.
比较TPF方案与FOLFOX方案在局部不可切除的晚期胃癌（LAUGC）转化治疗中的疗效和安全性，并确定影响临床结局的预后因素。
这项回顾性研究分析了2019年至2021年间接受TPF方案（n = 140）或FOLFOX方案（n = 124）治疗的264例LAUGC患者。主要终点为客观缓解率（ORR）和1年生存率；次要终点包括转化手术率、毒性和3年生存率。使用多变量Cox回归和时间依赖性ROC分析评估预后因素。
与FOLFOX组相比，TPF组的ORR（P = 0.01）和疾病控制率（DCR；P < 0.001）显著更高。转化手术率（P = 0.011）和R0切除率（P = 0.003）也有所提高。TPF队列的1年生存率更高（P < 0.05），而3年生存率无显著差异（P > 0.05）。虽然TPF导致的骨髓抑制更频繁（P = 0.002），但两组间严重不良事件的发生率相当。多变量分析确定FOLFOX方案、癌胚抗原（CEA）升高和N3期为1年死亡率的危险因素，而较高的白蛋白水平和淋巴细胞计数具有保护作用。肿瘤大小≥5 cm和低分化与3年死亡风险增加相关。白蛋白对1年生存率具有较强的预测价值。
TPF方案可有效提高接受转化治疗的LAUGC患者的客观缓解率和短期生存率，且骨髓抑制可控。对预后危险因素的分析有助于制定个体化治疗策略。
