TPF regimen improves conversion surgery and short-term survival in patients with locally unresectable advanced gastric cancer.

OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.