Prognosis analysis of palliative chemotherapy combined with radical local gastric surgery for advanced gastric cancer patients with single non-curable factor

Prognosis analysis of palliative chemotherapy combined with radical local gastric surgery for advanced gastric cancer patients with single non-curable factor | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Prognosis analysis of palliative chemotherapy combined with radical local gastric surgery for advanced gastric cancer patients with single non-curable factor Tao Zheng, Yizhen Chen, Shengtao Lin, Changshun Yang, Weihua Li This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4565544/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract There are limited studies on the treatment of patients with advanced gastric cancer with a single non-curable factor by palliative chemotherapy (PC) combined with local radical gastrectomy (LRG).In this study, our aim is to analyze the effectiveness and safety of palliative chemotherapy combined with local radical gastrectomy(PC-LRG)for patients with advanced gastric cancer with a single non-resectable factor. We retrospectively analyzed the patients with advanced gastric cancer with a single unresectable factor who received first-line chemotherapy in Fujian Provincial Hospital from January 2017 to June 2023. In total, 69 consecutive patients were enrolled into the PC(39 patients) and LRG-PC (30 patients) group. The primary research endpoint is the overall survival (OS) of patients in both groups, and the secondary research endpoint is the time of resistance to the first-line chemotherapy protocol.The OS of the PC-LGR group (20.0 VS 10.0 months, P<0.0001) and the time for changing the first-line chemotherapy plan (7.5 VS 3.2 cycles, p<0.05) were significantly better. There was statistical significance between the average total number of chemotherapy cycles of the two groups (8.7 VS 6.1, p<0.05). The incidence of grade III or higher adverse reactions to chemotherapy in the PC group (12.8% VS 33.3%, p=0.41) was better than that in the PC-LGR group.For patients with advanced gastric cancer who have a single non-reversible factor, PC-LGR may reduce tumor burden, improve tolerance to chemotherapy drugs, and prolong the OS of patients. advanced gastric gastrectomy palliative chemotherapy Figures Figure 1 Figure 2 Background Gastric cancer is the third most common cause of cancer-related deaths globally 1 - 2 - 3 . The prognosis of patients with advanced gastric cancer is poor, and those with a single non-curable factor are currently treated primarily with palliative chemotherapy, palliative surgery, and bypass surgery 2 . Generally speaking, the combined chemotherapy of 5-FU or cisplatin is widely used in clinic 4 , with a remission rate of about 30%-40% and a median OS of 9-11 months. Recently, more progress has been made in the combination of conventional chemotherapy with immunotherapy, targeted therapy, and surgical treatment 5 - 6 - 7 - 8 - 9 . Although most patients with advanced gastric cancer with a single non-curable factor initially respond to chemotherapy, the tumor will eventually progress. Currently, the main treatment for such patients is still combined therapy based on chemotherapy. For a minority of patients who are eligible for R0 resection after chemotherapy and immunotherapy, surgical treatment after chemotherapy can improve their prognosis 10 - 11 However, it remains to be explored whether surgery can improve the prognosis of patients who undergo local radical gastric surgery, i.e., the primary tumor can be completely resected, but the metastatic lesion cannot be radically resected 12 - 13 - 14 - 15 . The purpose of this study is to explore the effectiveness and safety of palliative chemotherapy combined with local radical gastrectomy in patients with advanced gastric cancer with a single non-curable factor. Materials and Methods 2.1 General information: patients with advanced gastric cancer with a single non-curable factor admitted to Fujian Provincial Hospital from January 2017 to June 2023 were selected. Patients who met the criteria were automatically divided into palliative chemotherapy group (PC) and palliative chemotherapy combined with local gastric radical surgery group (PC-LRG) based on whether they underwent local gastric radical surgery. Cases were strictly screened according to the following criteria: 1) Age: 18-80 years; 2) Presence of a single incurable factor at initial diagnosis (liver metastasis, abdominal metastasis, para-aortic lymph node metastasis); 3) Gastric adenocarcinoma confirmed by gastroscope histopathology; 4) Confirmation of gastric cancer by CT, PET-CT, or laparoscopic exploration; 5) Diagnosis of stage IV according to the eighth edition of the UICC staging system 16 ; 6) Initial treatment with first-line palliative chemotherapy; 7) Complete medical records; 8) No history of previous radiotherapy or chemotherapy. Exclusion criteria: 1) multiple metastases; 2) history of other malignant tumors; 3) initial palliative surgery due to complications; 4) serious adverse reactions to chemotherapy; 5) rare types of gastric cancer such as neuroendocrine carcinoma; 6) death due to non-gastric cancer and its complications. All gastric cancer patients provided written informed consent. All patients signed written informed consent, and this study was approved by the ethics committee of the Fujian Provincial Hospital. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki, the national legislation, and the institutional requirements. 2.2 Treatment process: From 2017 to 2023, the Provincial Hospital treated 1053 gastric cancer patients, of which 69 were IV-stage gastric cancer patients with a single non-curable factor. These cases were regularly discussed at multidisciplinary meetings to explore treatment methods based on the effective guidelines at that time. The 69 patients were grouped according to the treatments they received: 1) patients who received only palliative chemotherapy, 2) patients who received palliative chemotherapy and then underwent surgical resection of the primary tumor after evaluation. All patients who received surgical treatment underwent postoperative chemotherapy. 2.3 Definition: The primary endpoint of this study is OS. The secondary endpoint is the time for patients to develop resistance to first-line chemotherapy. The definition of OS: the time from the patient's enrollment to death caused by tumor, loss of follow-up, or termination of follow-up. Palliative chemotherapy: refers to chemotherapy used for patients with advanced gastric cancer that cannot be completely cured. The purpose is to alleviate the patient's symptoms and delay the progression of the tumor. Local radical resection: refers to the complete resection of the primary lesion through surgery, aiming to reduce the patient's tumor burden, delay the progression of the tumor, and provide an environment for chemotherapy. According to the RECIST standard version 1.1, the response to chemotherapy is defined as complete remission (CR), partial remission (PR), stable disease (SD), or disease progression (PD) 17 . Chemotherapy adverse reactions are divided into grades 1-5 according to the CTCAE standard. 2.4 Data collection and follow-up: Baseline characteristics and disease course (such as postoperative complications and hospital stay) were obtained from the electronic medical record system of the center. Starting from the enrollment, patients were followed up until June 30, 2023, and adverse events were evaluated through oral interviews and blood tests every month, including complete blood cell count, liver and kidney function evaluation. Abdominal CT examination was conducted every three months, and the measurement of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA-199) was performed after the operation. The changes of CEA and CA-199 tumor markers were divided into stable (no change compared with before), improved (restored to normal level), and deteriorated (higher than normal level). 2.5 Statistical analysis: Fisher's exact test and corrected chi-square test were used to compare the characteristics of patients and baseline between the two groups. Kaplan-Meier survival curves were used to analyze OS in both groups. Cox proportional hazards multivariate regression model was adopted to evaluate the relationship between clinical variables and OS. First, univariate analysis was performed, p<0.05 was considered statistically significant and relevant factors (p<0.1) were included in the multivariate analysis. In the multivariate analysis, p<0.05 was considered as an independent predictor of OS. The data results of this study were analyzed using SPSS (version 26, SPSS Inc., Chicago, IL, USA). Results 3.1 Enrollment results (Figure 1): A total of 1053 gastric cancer patients from the Provincial Hospital between 2017 and 2023 were statistically analyzed. Among them, 846 patients were diagnosed with non-stage IV gastric cancer according to the UICC 8th Edition staging system, and 207 patients were diagnosed with stage IV gastric cancer. Among them, 75 patients initially received palliative surgery, and 132 patients received initial treatment as conversion therapy. Among the 63 patients who underwent R0 resection, 15 had severe organ failure, 6 died due to non-tumor factors, 22 were lost to follow-up, 5 had a history of other malignancies, and 7 underwent emergency surgery. Finally, 39 patients were enrolled in the PC group and 30 patients were enrolled in the PC-LRG group. 3.2 Patient characteristics (Table 1): The number of patients aged ≤60 years and >60 years in the PC group and the PC-LGR group were 17/22 and 13/17 respectively; the male-to-female ratios were 10/29 and 8/22 respectively; the number of patients with cT grades T3 and T4 after admission were 5/34 and 5/25 respectively; the number of patients with cN grades N1-N3 and Nx were 1/38 and 1/29 respectively; the reasons for the diagnosis of stage IV disease varied, including peritoneal metastasis in 20 and 14 patients respectively, liver metastasis in 12 and 9 patients respectively, and distant lymph node metastasis in 7 and 7 patients respectively. The number of patients with normal and elevated CEA values were 22/17 and 15/15 respectively, and the number of patients with normal and elevated CA-199 values were 21/18 and 14/16 respectively. There were no statistically significant differences between the two groups in terms of age composition, gender ratio, local infiltration, lymphatic metastasis, distant metastasis, and initial imaging assessment time. 3.3 Chemotherapy-related information (Table 2): In the PC group and PC-LGR group, the initial chemotherapy regimens were platinum + fluorouracil for 17 and 14 patients respectively; paclitaxel + fluorouracil for 9 and 5 patients respectively; platinum + fluorouracil + paclitaxel for 9 and 8 patients respectively; and other chemotherapy regimens for 4 and 3 patients respectively. There was no significant statistical difference in the choice of initial first-line chemotherapy regimens between the two groups. The median number of chemotherapy cycles in the two groups was 5 and 8 respectively, with a significant statistical difference between them. The average cycle for changing the first-line chemotherapy regimen in the two groups was 3.2 cycles and 7.4 cycles respectively. The number of patients with grade III or higher adverse reactions to chemotherapy in the surgical group was 10, and the number in the chemotherapy group was 5, with a statistical difference between the two groups, indicating that the chemotherapy group was superior to the surgical group. 3.4 Surgical Information: The average number of cycles for patients in the PC-LGR group was 3.3. The recovery time for the digestive tract was 3.2 days. Postoperative complications of grade II or below occurred in 2 patients, with no grade III or above complications. The changes in CEA before surgery were as follows: 14 patients improved, 11 patients remained stable, and 5 patients worsened. The changes in CEA 1-3 months after surgery were as follows: 1 patient improved, 17 patients remained stable, and 12 patients worsened. The changes in CA-199 before surgery in the PC-LGR group were as follows: 12 patients improved, 11 patients remained stable, and 7 patients worsened. The changes in CA-199 1-3 months after surgery were as follows: 3 patients improved, 13 patients remained stable, and 14 patients worsened. In group 2, the surgical methods were as follows: 20 patients underwent TG and 10 patients underwent DG, all of whom underwent D2 lymph node dissection. Postoperative pathological staging showed that 15 patients had local infiltration stage ≤T3 and 15 patients had stage T4. Lymph node metastasis staging was N0-N1 in 10 patients and N2-N3 in 20 patients. The postoperative complication rate of grade II or below was 6.7% (2/30), with no grade III or above complications. 3.5 Patient Comprehensive Survival Analysis: Based on the KM survival analysis curve(Figure 2), the median OS of patients was 10 months (PC) and 20 months (LGR, p<0.05). Combined with Table 3-4, according to COX univariate analysis, grouping (p<0.05), number of chemotherapy cycles (p=0.008), timing of chemotherapy regimen change (p<0.05), initial evaluation of local response to chemotherapy (p=0.012), and initial evaluation of metastatic response to chemotherapy (p=0.010) were significantly associated with better OS in patients. Through multivariate analysis, surgery, number of chemotherapy cycles, and response of metastatic lesions to chemotherapy during the initial evaluation were identified as factors affecting patient survival (Table 3). According to COX univariate analysis, postoperative CEA levels (p=0.002) and postoperative CA-199 levels (p=0.004) within 1-3 months were found to have statistically significant relationships with patient survival in the PC-LGR group. To further explore which patients could benefit from the combined treatment group, we conducted a Cox multivariate regression analysis on patients in the combined treatment group. COX multivariate analysis revealed that changes in postoperative CEA, changes in postoperative CA-199, and the number of continued chemotherapy cycles after surgery would affect the survival of surgical patients (Table 4). Discussion The prognosis of patients with stage IV gastric cancer is usually poor, and mainly palliative chemotherapy is adopted. Palliative surgery is only selected for patients with complications such as bleeding, obstruction, and perforation caused by the tumor 18 . In recent years, with the development of the concept of comprehensive treatment, combined treatment methods based on palliative chemotherapy have been developed 19 . However, the prognosis of most patients with single distant metastasis of advanced gastric cancer is still not ideal 20 . Whether local radical surgery can improve the prognosis of such patients remains to be studied. In our study, the OS of patients in the PC-LGR group was significantly higher than that in the PC group, indicating that for patients with a single non-curable factor, local radical surgery can effectively improve survival. A REGTTA study in 2016 based on interim analysis suggested that radical surgery combined with postoperative chemotherapy was not beneficial for survival outcomes in patients with advanced gastric cancer with a single non-curable factor and the trial was terminated early 21 . The study speculated that the decrease in patient compliance after surgery may be the reason for the discrepancy between the trial and the expected results. In our study, patients received long-term chemotherapy after surgery and had relatively good compliance. At the same time, most patients in this study responded to chemotherapy, and local radical surgery effectively reduced the tumor burden in the body, creating conditions for continued chemotherapy. In addition, good postoperative management and the development of chemotherapy drugs may have contributed to improved postoperative compliance 22-24 . Two studies have shown that postoperative compliance may be related to age, postoperative infection, and tumor TNM staging 25 - 26 . There were no significant differences between the two groups in the initial clinical staging of the tumor, the time of initial chemotherapy evaluation, and the response to chemotherapy after evaluation. However, the combined surgery group had a longer average chemotherapy cycle and a later time to change the first-line chemotherapy regimen. This indicates that patients receiving local radical surgery may have better tolerance to chemotherapy. At the same time, patients who respond to chemotherapy may maintain or even improve their sensitivity to chemotherapy after radical surgery. In terms of the evaluation of chemotherapy response, a retrospective study in 2018 found that local chemotherapy response may be more suitable for patients receiving local surgery 19 . Therefore, this study divides chemotherapy response into chemotherapy response of primary lesion and chemotherapy response of metastatic site. The study found that the primary lesion had no significant effect on the survival of patients. The possible reason is that the patients in the PC-LGR group achieved complete resection of the primary lesion under the naked eye after chemotherapy. In the chemotherapy response of metastatic sites, the prognosis of patients with PR/SD was significantly better than that of patients with PD. Metastatic lesions are the key factors affecting prognosis. This may indicate that the elimination of the risk factor of the primary tumor through surgery can improve the survival of patients. At the same time, the chemotherapy response of the metastatic site in patients with response to the primary lesion can better reflect their prognosis. In terms of adverse reactions to chemotherapy, the incidence of grade III adverse reactions in the PC-LRG group was higher than that in the PC group. Although the COX univariate analysis showed that the occurrence of adverse reactions to chemotherapy did not directly affect the survival cycle of patients, it prolonged the interval time of chemotherapy and increased the risk of hospitalization. The possible reasons are that patients in the PC-LGR group had a longer average number of chemotherapy cycles, which increased the probability of adverse reactions to chemotherapy 27 . Another reason may be that the invasiveness of chemotherapy combined with local radical gastrectomy is greater than that of chemotherapy alone, resulting in asymmetric balance between the two groups 21 . Regarding the best time for surgery, although some studies indicate that the average interval time for resection after chemotherapy is about 126 days 28 , other studies suggest that 2 to 6 weeks after neoadjuvant chemotherapy may be sufficient 29 . We have studied whether the time interval between chemotherapy and surgery affects the overall outcome. However, in the univariate analysis, the interval time did not have statistically significant impact on the patient's final survival. It is possible that the interval between chemotherapy and surgery is not a good indicator for assessing the timing of surgery. We still need more preoperative indicators to assess the timing of surgery for patients. Currently, radical surgical treatment is mainly aimed at advanced gastric cancer patients who are eligible for R0 resection 19 . However, there is still controversy about whether surgery should be performed on advanced gastric cancer patients who still have non-curable factors after chemotherapy. Our research results indicate that preoperative chemotherapy combined with local gastric radical surgery can effectively improve the OS of patients with advanced gastric cancer with a single non-curable factor. There are still some limitations in our research. Firstly, we used a retrospective design to study patients from a single institution. Due to the retrospective design, preoperative chemotherapy protocols and surgical timing may vary, which may lead to biases. Secondly, there may be selection biases in patients who respond well to chemotherapy. Thirdly, the quality of life was not evaluated in this retrospective study, which is a key consideration for patients with limited lifespan when selecting the best treatment strategy. Finally, due to the small size of the cohort in this study, type II errors in some subgroup analyses must be considered. Conclusion In conclusion, the prognosis of patients with advanced gastric cancer is still not ideal. However, our research has provided some ideas for the comprehensive treatment of patients with advanced gastric cancer with a single non-curable factor. Currently, large-scale, prospective, multicenter, randomized trials are needed to further confirm the best treatment strategy. At the same time, it is urgent to further evaluate the best time between chemotherapy and surgery, assess the best response time of chemotherapy, strengthen the management of postoperative patients, and find pathological evidence that affects the prognosis of patients. Declarations Data availability The data that support the findings of this study are available from the corresponding author upon reasonable request. Author contributions T.Z.: Contributed to conception and design; contributed to acquisition, analysis and interpretation; and drafted the manuscript. Y.C.: Contributed to interpretation; and critically revised the manuscript. S.L.: Contributed to analysis; critically revised the manuscript. C.Y.: Contributed to conception; and critically revised the manuscript. W.L.: Contributed to conception and design; contributed to acquisition, analysis and interpretation; and critically revised the manuscript All authors gave their final approval and agree to be accountable for all aspects of the work. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Competing interests The authors declare no competing interests. Additional information Correspondence and requests for materials should be addressed to W.L. References Sung, H. et al. 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Tables Table1：Baseline Characteristics PC PC-LRG Characteristics (n=39) (n=30) p Age，n(%) 0.983 ≤60y 17（43.59） 13（43.33） ＞60y 22（56.41） 17（56.67） Sex，n(%) 0.923 Female 10（25.64） 8（26.67） Male 29（74.36） 22（73.33） ASA grade,n(%) ＜III NA 13（43.33） ≥III NA 17（56.67） cT stage,n(%) 0.737 T3 5（12.82） 5（16.67） T4 34（87.18） 25（83.33） cN stage,n(%) 0.85 N1-N3 1（2.56） 1（3.33） Nx 38（97.44） 29（96.67） Type of distant metastasis,n(%) 0.902 Peritoneal carcinomatosis 20（51.28） 14（46.67） Liver metastasis 12（30.77） 9（30.00） Distant LN metastasis 7（17.95） 7（23.33） CEA,n(%)（＜5ng/ml） 0.387 Normal 22（56.41） 15（50.00） Worse 17（43.59） 15（50.00） CA-199,n(%)（＜27U/ml） 0.364 Normal 21（53.85） 14（46.67） Worse 18（46.15） 16（53.33） Patient baseline characteristics in the PC and PC-LGR groups. Fisher’s exact test was used as an alternative to Chi-square test when the number in one of the cells is smaller than 5. PC palliative chemotherapy. PC-LGR palliative chemotherapy combined with local radical gastrectomy. Table 2 Chemotherapy-related factors Variables PC，N PC-LRG，N P 39 30 chemotherapy regimen 0.951 Platinum + FU 17 14 Taxane + FU 9 5 Platinum+ Taxane + FU 9 8 Others 4 3 Chemotherapy cycle（median） 5 8 p＜0.01 adverse reactions related to chemotherapy 0.047 1-2 34 20 3-5 5 10 Change of chemotherapy regimen（Average cycle） 3.2 7.4 Preop.response Local region p＝0.51 PR/SD 34 27 PD 5 3 Metastatic site p＝0.57 PR/SD 25 19 PD 14 11 Initial imaging evaluation 0.370 ≤3 10（25.64） 5（16.67） ＞3 29（74.36） 25（83.33） Comparison of chemotherapy-related parameters between PC group and PC-LRG group.Fisher’s exact test was used as an alternative to Chi-square test when the number in one of the cells is smaller than 5. PC palliative chemotherapy. PC-LGR palliative chemotherapy combined with local radical gastrectomy. Table 3 Cox proportional hazard model of overall survival Prognostic factor n Univariate HR (95% CI) P Multivariate HR (95% CI) P Group ＜0.05 0.011 Chemotherapy 39 1 Surgery 30 0.371（0.222-0.620） Gender 0.349 Female 18 1 Male 51 0.763（0.438-1.329） Age（years） 0.696 ≤60 30 1 ＞60 39 1.1（0.681-1.778） cT-stage 0.580 T3 10 1 T4 59 0.818（0.402-1.666） Type of distant metastasis 0.952 Peritoneal carcinomatosis 34 1 Liver metastasis 21 1.033（0.593-1.795） Distant LN metastasis 14 1.106（0.590-2.076） CEA 0.448 Normal 39 1 Worse 30 1.209（0.746-1.961） CA-199 0.757 Normal 37 1 Worse 32 1.079（0.667-1.744） Initial imaging evaluation 0.849 ≤3 54 1 ＞3 15 0.001（0.0001-8.818） chemotherapy regimen 0.642 Platinum + FU 31 1 Taxane + FU 14 0.816（0.430-1.551） Platinum+ Taxane + FU 17 0.697（0.382-1.270） Others 7 1.035（0.452-2.370） Chemotherapy cycle ＜0.05 0.007 ≤7 36 1 ＞7 33 0.304（0.181-0.511） Adverse reaction to chemotherapy 0.322 ≤2 54 1 ＞2 15 0.746（0.418-1.331） Change of chemotherapy regimen ＜0.05 0.994 ≤5 37 1 ＞5 32 0.344（0.206-0.574） Preop.response 0.22 Local region 0.012 PR/SD 62 1 PD 7 0.980（0.001-2.77） Metastatic site 0.01 0.001 PR/SD 44 1 PD 35 1.405（0.01-3.640） the final model was selected by a forward likelihood ratio method from the variables with p-value < 0.10 in a univariate Cox proportional hazard model The bold represents statistical significance Table 4 Cox proportional hazard model of overall survival for Group2 Prognostic factor n Univariate HR (95% CI) P Multivariate HR (95% CI) P ASA 0.586 I-II 13 1 III 17 0.814（0.390-1.701） Preoperative chemotherapy 0.832 ≤3 19 1 ＞3 11 1.087（0.503-2.351） Postoperative chemotherapy ＜0.05 0.037 ≤6 18 1 ＞6 12 0.150（0.053-0.428） Postop recovery 0.109 ＜3 17 1 ≥3 13 1.884（0.877-4.047） Postop days 0.280 ＜10 21 1 ≥10 9 1.580（0.705-3.540） Preoperative CEA 0.191 Improve 14 1 Stable 11 0.894（0.395-2.020） Worse 5 2.369（0.814-6.892） 1-3moth CEA 0.002 0.039 Improve 1 1 Stable 17 0.831（0.106-6.520） Worse 12 4.290（0.538-34.173） Preoperative CA-199 0.073 Improve 12 1 Stable 11 1.004（0.429-2.350） Worse 7 2.878（1.054-7.860） 1-3moth CA-199 0.001 0.015 Improve 3 1 Stable 13 0.296（0.073-1.199） Worse 14 3.004（0.778-11.591） Type of operation 0.371 TG 20 1 DG 10 1.425(0.646-3.142) yPT 0.236 ≤T3 15 1 T4 15 1.565（0.747-3.278） yPN 0.158 N0-N1 11 1 N2-N3 19 1.752（0.790-3.883） the final model was selected by a forward likelihood ratio method from the variables with p-value < 0.10 in a univariate Cox proportional hazard model The bold represents statistical significance Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4565544","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":322080853,"identity":"5e9dd13d-53fc-48f1-9d55-4915395bb820","order_by":0,"name":"Tao Zheng","email":"","orcid":"","institution":"Fujian Medical University and Fujian Provincial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tao","middleName":"","lastName":"Zheng","suffix":""},{"id":322080854,"identity":"f7ccdab1-42b8-4d3f-a32e-91604de710ad","order_by":1,"name":"Yizhen Chen","email":"","orcid":"","institution":"Fujian Medical University and Fujian Provincial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yizhen","middleName":"","lastName":"Chen","suffix":""},{"id":322080855,"identity":"8a8230ec-bfdf-48c8-b421-ef2e57bcadda","order_by":2,"name":"Shengtao Lin","email":"","orcid":"","institution":"Fujian Medical University and Fujian Provincial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shengtao","middleName":"","lastName":"Lin","suffix":""},{"id":322080856,"identity":"77ad67a2-376e-4502-92c6-199392771fea","order_by":3,"name":"Changshun Yang","email":"","orcid":"","institution":"Fujian Medical University and Fujian Provincial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Changshun","middleName":"","lastName":"Yang","suffix":""},{"id":322080857,"identity":"311b596e-b392-4cb9-b52b-456844cfeecf","order_by":4,"name":"Weihua Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAsUlEQVRIiWNgGAWjYBACPmYGNoYPNmxgjgRRWtiAWhhnpJGkBaSLJ42BFC3sPGaPbRL4og0OMB+8zcNgl0eEw3jMjXMS2HI3HGBLtuZhSC4mQgvvNuncHyAtPGbSPAwHEhuI0mIBtoX/GwlaGMBaeNiI1cL/TbIHqGXmYTZjyzkGyYS18PMfS5P4kXAst+9488MbbyrsCGuBgmMMDMwg2oBI9UBQQ7zSUTAKRsEoGHkAAA5wMJ9t+BdwAAAAAElFTkSuQmCC","orcid":"","institution":"Fujian Medical University and Fujian Provincial Hospital","correspondingAuthor":true,"prefix":"","firstName":"Weihua","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2024-06-11 16:36:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4565544/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4565544/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60443542,"identity":"f33a926b-b6e4-4392-a3e4-616601c2d4c5","added_by":"auto","created_at":"2024-07-16 20:21:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":515264,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4565544/v1/44bce6a2941cd9b076d042fe.png"},{"id":60443544,"identity":"435da652-8925-451a-b298-293fcd6aa96f","added_by":"auto","created_at":"2024-07-16 20:21:54","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":768045,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4565544/v1/4b6353e52754629cc1aa38b3.png"},{"id":61978120,"identity":"5d5d58dc-a6af-41f5-8ad6-98b4f07cf73c","added_by":"auto","created_at":"2024-08-07 19:32:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2330650,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4565544/v1/61a1d1d0-5090-4570-b7b3-96070671d08f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prognosis analysis of palliative chemotherapy combined with radical local gastric surgery for advanced gastric cancer patients with single non-curable factor","fulltext":[{"header":"Background","content":"\u003cp\u003eGastric cancer is the third most common cause of cancer-related deaths globally \u003csup\u003e1\u003c/sup\u003e\u003csup\u003e-\u003c/sup\u003e\u003csup\u003e2\u003c/sup\u003e\u003csup\u003e-\u003c/sup\u003e\u003csup\u003e3\u003c/sup\u003e. The prognosis of patients with advanced gastric cancer is poor, and those with a single non-curable factor are currently treated primarily with palliative chemotherapy, palliative surgery, and bypass surgery \u003csup\u003e2\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eGenerally speaking, the combined chemotherapy of 5-FU or cisplatin is widely used in clinic \u003csup\u003e4\u003c/sup\u003e, with a remission rate of about 30%-40% and a median OS of 9-11 months. Recently, more progress has been made in the combination of conventional chemotherapy with immunotherapy, targeted therapy, and surgical treatment \u003csup\u003e5\u003c/sup\u003e\u003csup\u003e-\u003c/sup\u003e\u003csup\u003e6\u003c/sup\u003e\u003csup\u003e-\u003c/sup\u003e\u003csup\u003e7\u003c/sup\u003e\u003csup\u003e-\u003c/sup\u003e\u003csup\u003e8\u003c/sup\u003e\u003csup\u003e-\u003c/sup\u003e\u003csup\u003e9\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eAlthough most patients with advanced gastric cancer with a single non-curable factor initially respond to chemotherapy, the tumor will eventually progress. Currently, the main treatment for such patients is still combined therapy based on chemotherapy. For a minority of patients who are eligible for R0 resection after chemotherapy and immunotherapy, surgical treatment after chemotherapy can improve their prognosis \u003csup\u003e10\u003c/sup\u003e\u003csup\u003e-\u003c/sup\u003e\u003csup\u003e11\u003c/sup\u003e However, it remains to be explored whether surgery can improve the prognosis of patients who undergo local radical gastric surgery, i.e., the primary tumor can be completely resected, but the metastatic lesion cannot be radically resected \u003csup\u003e12\u003c/sup\u003e\u003csup\u003e-\u003c/sup\u003e\u003csup\u003e13\u003c/sup\u003e\u003csup\u003e-\u003c/sup\u003e\u003csup\u003e14\u003c/sup\u003e\u003csup\u003e-\u003c/sup\u003e\u003csup\u003e15\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe purpose of this study is to explore the effectiveness and safety of palliative chemotherapy combined with local radical gastrectomy in patients with advanced gastric cancer with a single non-curable factor.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e2.1 General information: patients with advanced gastric cancer with a single non-curable factor admitted to Fujian Provincial Hospital from January 2017 to June 2023 were selected. Patients who met the criteria were automatically divided into palliative chemotherapy group (PC) and palliative chemotherapy combined with local gastric radical surgery group (PC-LRG) based on whether they underwent local gastric radical surgery. Cases were strictly screened according to the following criteria: 1) Age: 18-80 years; 2) Presence of a single incurable factor at initial diagnosis (liver metastasis, abdominal metastasis, para-aortic lymph node metastasis); 3) Gastric adenocarcinoma confirmed by gastroscope histopathology; 4) Confirmation of gastric cancer by CT, PET-CT, or laparoscopic exploration; 5) Diagnosis of stage IV according to the eighth edition of the UICC staging system \u003csup\u003e16\u003c/sup\u003e; 6) Initial treatment with first-line palliative chemotherapy; 7) Complete medical records; 8) No history of previous radiotherapy or chemotherapy. Exclusion criteria: 1) multiple metastases; 2) history of other malignant tumors; 3) initial palliative surgery due to complications; 4) serious adverse reactions to chemotherapy; 5) rare types of gastric cancer such as neuroendocrine carcinoma; 6) death due to non-gastric cancer and its complications. All gastric cancer patients provided written informed consent. \u003c/p\u003e\n\u003cp\u003eAll patients signed written informed consent, and this study was approved by the ethics committee of the Fujian Provincial Hospital. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki, the national legislation, and the institutional requirements.\u003c/p\u003e\n\n\u003cp\u003e2.2 Treatment process: From 2017 to 2023, the Provincial Hospital treated 1053 gastric cancer patients, of which 69 were IV-stage gastric cancer patients with a single non-curable factor. These cases were regularly discussed at multidisciplinary meetings to explore treatment methods based on the effective guidelines at that time. The 69 patients were grouped according to the treatments they received: 1) patients who received only palliative chemotherapy, 2) patients who received palliative chemotherapy and then underwent surgical resection of the primary tumor after evaluation. All patients who received surgical treatment underwent postoperative chemotherapy.\u003c/p\u003e\n\u003cp\u003e2.3 Definition: The primary endpoint of this study is OS. The secondary endpoint is the time for patients to develop resistance to first-line chemotherapy. The definition of OS: the time from the patient\u0026apos;s enrollment to death caused by tumor, loss of follow-up, or termination of follow-up. Palliative chemotherapy: refers to chemotherapy used for patients with advanced gastric cancer that cannot be completely cured. The purpose is to alleviate the patient\u0026apos;s symptoms and delay the progression of the tumor. Local radical resection: refers to the complete resection of the primary lesion through surgery, aiming to reduce the patient\u0026apos;s tumor burden, delay the progression of the tumor, and provide an environment for chemotherapy. According to the RECIST standard version 1.1, the response to chemotherapy is defined as complete remission (CR), partial remission (PR), stable disease (SD), or disease progression (PD) \u003csup\u003e17\u003c/sup\u003e. Chemotherapy adverse reactions are divided into grades 1-5 according to the CTCAE standard.\u003c/p\u003e\n\u003cp\u003e2.4 Data collection and follow-up: Baseline characteristics and disease course (such as postoperative complications and hospital stay) were obtained from the electronic medical record system of the center. Starting from the enrollment, patients were followed up until June 30, 2023, and adverse events were evaluated through oral interviews and blood tests every month, including complete blood cell count, liver and kidney function evaluation. Abdominal CT examination was conducted every three months, and the measurement of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA-199) was performed after the operation. The changes of CEA and CA-199 tumor markers were divided into stable (no change compared with before), improved (restored to normal level), and deteriorated (higher than normal level).\u003c/p\u003e\n\u003cp\u003e2.5 Statistical analysis: Fisher\u0026apos;s exact test and corrected chi-square test were used to compare the characteristics of patients and baseline between the two groups. Kaplan-Meier survival curves were used to analyze OS in both groups. Cox proportional hazards multivariate regression model was adopted to evaluate the relationship between clinical variables and OS. First, univariate analysis was performed, p\u0026lt;0.05 was considered statistically significant and relevant factors (p\u0026lt;0.1) were included in the multivariate analysis. In the multivariate analysis, p\u0026lt;0.05 was considered as an independent predictor of OS. The data results of this study were analyzed using SPSS (version 26, SPSS Inc., Chicago, IL, USA).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e3.1 Enrollment results (Figure 1): A total of 1053 gastric cancer patients from the Provincial Hospital between 2017 and 2023 were statistically analyzed. Among them, 846 patients were diagnosed with non-stage IV gastric cancer according to the UICC 8th Edition staging system, and 207 patients were diagnosed with stage IV gastric cancer. Among them, 75 patients initially received palliative surgery, and 132 patients received initial treatment as conversion therapy. Among the 63 patients who underwent R0 resection, 15 had severe organ failure, 6 died due to non-tumor factors, 22 were lost to follow-up, 5 had a history of other malignancies, and 7 underwent emergency surgery. Finally, 39 patients were enrolled in the PC group and 30 patients were enrolled in the PC-LRG group.\u003c/p\u003e\n\u003cp\u003e3.2 Patient characteristics (Table 1): The number of patients aged \u0026le;60 years and \u0026gt;60 years in the PC group and the PC-LGR group were 17/22 and 13/17 respectively; the male-to-female ratios were 10/29 and 8/22 respectively; the number of patients with cT grades T3 and T4 after admission were 5/34 and 5/25 respectively; the number of patients with cN grades N1-N3 and Nx were 1/38 and 1/29 respectively; the reasons for the diagnosis of stage IV disease varied, including peritoneal metastasis in 20 and 14 patients respectively, liver metastasis in 12 and 9 patients respectively, and distant lymph node metastasis in 7 and 7 patients respectively. The number of patients with normal and elevated CEA values were 22/17 and 15/15 respectively, and the number of patients with normal and elevated CA-199 values were 21/18 and 14/16 respectively. There were no statistically significant differences between the two groups in terms of age composition, gender ratio, local infiltration, lymphatic metastasis, distant metastasis, and initial imaging assessment time.\u003c/p\u003e\n\u003cp\u003e3.3 Chemotherapy-related information (Table 2): In the PC group and PC-LGR group, the initial chemotherapy regimens were platinum + fluorouracil for 17 and 14 patients respectively; paclitaxel + fluorouracil for 9 and 5 patients respectively; platinum + fluorouracil + paclitaxel for 9 and 8 patients respectively; and other chemotherapy regimens for 4 and 3 patients respectively. There was no significant statistical difference in the choice of initial first-line chemotherapy regimens between the two groups. The median number of chemotherapy cycles in the two groups was 5 and 8 respectively, with a significant statistical difference between them. The average cycle for changing the first-line chemotherapy regimen in the two groups was 3.2 cycles and 7.4 cycles respectively. The number of patients with grade III or higher adverse reactions to chemotherapy in the surgical group was 10, and the number in the chemotherapy group was 5, with a statistical difference between the two groups, indicating that the chemotherapy group was superior to the surgical group.\u003c/p\u003e\n\u003cp\u003e3.4 Surgical Information: The average number of cycles for patients in the PC-LGR group was 3.3. The recovery time for the digestive tract was 3.2 days. Postoperative complications of grade II or below occurred in 2 patients, with no grade III or above complications. The changes in CEA before surgery were as follows: 14 patients improved, 11 patients remained stable, and 5 patients worsened. The changes in CEA 1-3 months after surgery were as follows: 1 patient improved, 17 patients remained stable, and 12 patients worsened. The changes in CA-199 before surgery in the PC-LGR group were as follows: 12 patients improved, 11 patients remained stable, and 7 patients worsened. The changes in CA-199 1-3 months after surgery were as follows: 3 patients improved, 13 patients remained stable, and 14 patients worsened. In group 2, the surgical methods were as follows: 20 patients underwent TG and 10 patients underwent DG, all of whom underwent D2 lymph node dissection. Postoperative pathological staging showed that 15 patients had local infiltration stage \u0026le;T3 and 15 patients had stage T4. Lymph node metastasis staging was N0-N1 in 10 patients and N2-N3 in 20 patients. The postoperative complication rate of grade II or below was 6.7% (2/30), with no grade III or above complications.\u003c/p\u003e\n\u003cp\u003e3.5 Patient Comprehensive Survival Analysis: Based on the KM survival analysis curve(Figure 2), the median OS of patients was 10 months (PC) and 20 months (LGR, p\u0026lt;0.05). Combined with Table 3-4, according to COX univariate analysis, grouping (p\u0026lt;0.05), number of chemotherapy cycles (p=0.008), timing of chemotherapy regimen change (p\u0026lt;0.05), initial evaluation of local response to chemotherapy (p=0.012), and initial evaluation of metastatic response to chemotherapy (p=0.010) were significantly associated with better OS in patients. Through multivariate analysis, surgery, number of chemotherapy cycles, and response of metastatic lesions to chemotherapy during the initial evaluation were identified as factors affecting patient survival (Table 3). According to COX univariate analysis, postoperative CEA levels (p=0.002) and postoperative CA-199 levels (p=0.004) within 1-3 months were found to have statistically significant relationships with patient survival in the PC-LGR group. To further explore which patients could benefit from the combined treatment group, we conducted a Cox multivariate regression analysis on patients in the combined treatment group. COX multivariate analysis revealed that changes in postoperative CEA, changes in postoperative CA-199, and the number of continued chemotherapy cycles after surgery would affect the survival of surgical patients (Table 4).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe prognosis of patients with stage IV gastric cancer is usually poor, and mainly palliative chemotherapy is adopted. Palliative surgery is only selected for patients with complications such as bleeding, obstruction, and perforation caused by the tumor \u003csup\u003e18\u003c/sup\u003e. In recent years, with the development of the concept of comprehensive treatment, combined treatment methods based on palliative chemotherapy have been developed \u003csup\u003e19\u003c/sup\u003e. However, the prognosis of most patients with single distant metastasis of advanced gastric cancer is still not ideal\u003csup\u003e20\u003c/sup\u003e. Whether local radical surgery can improve the prognosis of such patients remains to be studied.\u003c/p\u003e\n\u003cp\u003eIn our study, the OS of patients in the PC-LGR group was significantly higher than that in the PC group, indicating that for patients with a single non-curable factor, local radical surgery can effectively improve survival. A REGTTA study in 2016 based on interim analysis suggested that radical surgery combined with postoperative chemotherapy was not beneficial for survival outcomes in patients with advanced gastric cancer with a single non-curable factor and the trial was terminated early\u003csup\u003e21\u003c/sup\u003e. The study speculated that the decrease in patient compliance after surgery may be the reason for the discrepancy between the trial and the expected results. In our study, patients received long-term chemotherapy after surgery and had relatively good compliance. At the same time, most patients in this study responded to chemotherapy, and local radical surgery effectively reduced the tumor burden in the body, creating conditions for continued chemotherapy. In addition, good postoperative management and the development of chemotherapy drugs may have contributed to improved postoperative compliance\u003csup\u003e22-24\u003c/sup\u003e. Two studies have shown that postoperative compliance may be related to age, postoperative infection, and tumor TNM staging \u003csup\u003e25\u003c/sup\u003e\u003csup\u003e-\u003c/sup\u003e\u003csup\u003e26\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThere were no significant differences between the two groups in the initial clinical staging of the tumor, the time of initial chemotherapy evaluation, and the response to chemotherapy after evaluation. However, the combined surgery group had a longer average chemotherapy cycle and a later time to change the first-line chemotherapy regimen. This indicates that patients receiving local radical surgery may have better tolerance to chemotherapy. At the same time, patients who respond to chemotherapy may maintain or even improve their sensitivity to chemotherapy after radical surgery.\u003c/p\u003e\n\u003cp\u003eIn terms of the evaluation of chemotherapy response, a retrospective study in 2018 found that local chemotherapy response may be more suitable for patients receiving local surgery\u003csup\u003e19\u003c/sup\u003e. Therefore, this study divides chemotherapy response into chemotherapy response of primary lesion and chemotherapy response of metastatic site. The study found that the primary lesion had no significant effect on the survival of patients. The possible reason is that the patients in the PC-LGR group achieved complete resection of the primary lesion under the naked eye after chemotherapy. In the chemotherapy response of metastatic sites, the prognosis of patients with PR/SD was significantly better than that of patients with PD. Metastatic lesions are the key factors affecting prognosis. This may indicate that the elimination of the risk factor of the primary tumor through surgery can improve the survival of patients. At the same time, the chemotherapy response of the metastatic site in patients with response to the primary lesion can better reflect their prognosis.\u003c/p\u003e\n\u003cp\u003eIn terms of adverse reactions to chemotherapy, the incidence of grade III adverse reactions in the PC-LRG group was higher than that in the PC group. Although the COX univariate analysis showed that the occurrence of adverse reactions to chemotherapy did not directly affect the survival cycle of patients, it prolonged the interval time of chemotherapy and increased the risk of hospitalization. The possible reasons are that patients in the PC-LGR group had a longer average number of chemotherapy cycles, which increased the probability of adverse reactions to chemotherapy\u003csup\u003e27\u003c/sup\u003e. Another reason may be that the invasiveness of chemotherapy combined with local radical gastrectomy is greater than that of chemotherapy alone, resulting in asymmetric balance between the two groups \u003csup\u003e21\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eRegarding the best time for surgery, although some studies indicate that the average interval time for resection after chemotherapy is about 126 days \u003csup\u003e28\u003c/sup\u003e, other studies suggest that 2 to 6 weeks after neoadjuvant chemotherapy may be sufficient \u003csup\u003e29\u003c/sup\u003e. We have studied whether the time interval between chemotherapy and surgery affects the overall outcome. However, in the univariate analysis, the interval time did not have statistically significant impact on the patient\u0026apos;s final survival. It is possible that the interval between chemotherapy and surgery is not a good indicator for assessing the timing of surgery. We still need more preoperative indicators to assess the timing of surgery for patients.\u003c/p\u003e\n\u003cp\u003eCurrently, radical surgical treatment is mainly aimed at advanced gastric cancer patients who are eligible for R0 resection \u003csup\u003e19\u003c/sup\u003e. However, there is still controversy about whether surgery should be performed on advanced gastric cancer patients who still have non-curable factors after chemotherapy. Our research results indicate that preoperative chemotherapy combined with local gastric radical surgery can effectively improve the OS of patients with advanced gastric cancer with a single non-curable factor.\u003c/p\u003e\n\u003cp\u003eThere are still some limitations in our research. Firstly, we used a retrospective design to study patients from a single institution. Due to the retrospective design, preoperative chemotherapy protocols and surgical timing may vary, which may lead to biases. Secondly, there may be selection biases in patients who respond well to chemotherapy. Thirdly, the quality of life was not evaluated in this retrospective study, which is a key consideration for patients with limited lifespan when selecting the best treatment strategy. Finally, due to the small size of the cohort in this study, type II errors in some subgroup analyses must be considered.\u003c/p\u003e\n"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, the prognosis of patients with advanced gastric cancer is still not ideal. However, our research has provided some ideas for the comprehensive treatment of patients with advanced gastric cancer with a single non-curable factor. Currently, large-scale, prospective, multicenter, randomized trials are needed to further confirm the best treatment strategy. At the same time, it is urgent to further evaluate the best time between chemotherapy and surgery, assess the best response time of chemotherapy, strengthen the management of postoperative patients, and find pathological evidence that affects the prognosis of patients.\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003eData availability\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003eAuthor contributions\u003c/p\u003e\n\u003cp\u003eT.Z.: Contributed to conception and design; contributed to acquisition, analysis and interpretation; and drafted the manuscript. Y.C.: Contributed to interpretation; and critically revised the manuscript. S.L.: Contributed to analysis; critically revised the manuscript. C.Y.: Contributed to conception; and critically revised the manuscript. W.L.: Contributed to conception and design; contributed to acquisition, analysis and interpretation; and critically revised the manuscript All authors gave their final approval and agree to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Funding\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Competing interests\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Additional information\u003c/p\u003e\n\u003cp\u003eCorrespondence and requests for materials should be addressed to W.L.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSung, H.\u003cem\u003e et al.\u003c/em\u003e Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. \u003cem\u003eCA Cancer J Clin\u003c/em\u003e \u003cstrong\u003e71\u003c/strong\u003e, 209-249, doi:10.3322/caac.21660 (2021).\u003c/li\u003e\n\u003cli\u003eAjani, J. 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The Prognostic Significance of Compliance with Postoperative Adjuvant Chemotherapy in Patients with Stage III Gastric Cancer: an Observational Study. \u003cem\u003eJ Gastric Cancer\u003c/em\u003e \u003cstrong\u003e18\u003c/strong\u003e, 48-57, doi:10.5230/jgc.2018.18.e4 (2018).\u003c/li\u003e\n\u003cli\u003eTong, F.\u003cem\u003e et al.\u003c/em\u003e [Clinical evaluation of effects from neoadjuvant chemotherapy with epirubicin plus paclitaxel in cases of locally advanced breast cancer--comparative study of treatment with 2 and 4 cycles]. \u003cem\u003eGan To Kagaku Ryoho\u003c/em\u003e \u003cstrong\u003e31\u003c/strong\u003e, 205-208 (2004).\u003c/li\u003e\n\u003cli\u003eZhang, F.\u003cem\u003e et al.\u003c/em\u003e Conversion Surgery for Stage IV Gastric Cancer. \u003cem\u003eFront Oncol\u003c/em\u003e \u003cstrong\u003e9\u003c/strong\u003e, 1158, doi:10.3389/fonc.2019.01158 (2019).\u003c/li\u003e\n\u003cli\u003eYoshikawa, T.\u003cem\u003e et al.\u003c/em\u003e Induction of a pathological complete response by four courses of neoadjuvant chemotherapy for gastric cancer: early results of the randomized phase II COMPASS trial. \u003cem\u003eAnn Surg Oncol\u003c/em\u003e \u003cstrong\u003e21\u003c/strong\u003e, 213-219, doi:10.1245/s10434-013-3055-x (2014).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable1：Baseline Characteristics\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.901408450704224%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.619718309859154%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.028169014084508%\" valign=\"top\"\u003e\n \u003cp\u003ePC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.619718309859154%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.795774647887324%\" valign=\"top\"\u003e\n \u003cp\u003ePC-LRG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.619718309859154%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.795774647887324%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.619718309859154%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.646748681898067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.005272407732864%\" valign=\"top\"\u003e\n \u003cp\u003e(n=39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.599297012302285%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.775043936731107%\" valign=\"top\"\u003e\n \u003cp\u003e(n=30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.599297012302285%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.775043936731107%\" valign=\"top\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.599297012302285%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.646748681898067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eAge，n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.604569420035148%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.983\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.646748681898067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026le;60y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.604569420035148%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e17（43.59）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e13（43.33）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.646748681898067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e＞60y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.604569420035148%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e22（56.41）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e17（56.67）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.646748681898067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eSex，n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.604569420035148%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.923\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.646748681898067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.604569420035148%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e10（25.64）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e8（26.67）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.646748681898067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.604569420035148%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e29（74.36）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e22（73.33）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.646748681898067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eASA grade,n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.604569420035148%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.646748681898067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e＜III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.604569420035148%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e13（43.33）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.646748681898067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.604569420035148%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e17（56.67）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.646748681898067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003ecT stage,n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.604569420035148%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.737\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.646748681898067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eT3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.604569420035148%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e5（12.82）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e5（16.67）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.646748681898067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eT4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.604569420035148%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e34（87.18）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e25（83.33）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.646748681898067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003ecN stage,n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.604569420035148%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.646748681898067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eN1-N3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.604569420035148%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1（2.56）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1（3.33）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.646748681898067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNx\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.604569420035148%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e38（97.44）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e29（96.67）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.251318101933215%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eType of distant metastasis,n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.902\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.646748681898067%\" colspan=\"2\"\u003e\n \u003cp\u003ePeritoneal carcinomatosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.604569420035148%\" colspan=\"2\"\u003e\n \u003cp\u003e20（51.28）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\"\u003e\n \u003cp\u003e14（46.67）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.646748681898067%\" colspan=\"2\"\u003e\n \u003cp\u003eLiver metastasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.604569420035148%\" colspan=\"2\"\u003e\n \u003cp\u003e12（30.77）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\"\u003e\n \u003cp\u003e9（30.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.646748681898067%\" colspan=\"2\"\u003e\n \u003cp\u003eDistant LN metastasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.604569420035148%\" colspan=\"2\"\u003e\n \u003cp\u003e7（17.95）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\"\u003e\n \u003cp\u003e7（23.33）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.646748681898067%\" colspan=\"2\"\u003e\n \u003cp\u003eCEA,n(%)（＜5ng/ml）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.604569420035148%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.387\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.646748681898067%\" colspan=\"2\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.604569420035148%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e22（56.41）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e15（50.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.646748681898067%\" colspan=\"2\"\u003e\n \u003cp\u003eWorse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.604569420035148%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e17（43.59）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e15（50.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.646748681898067%\" colspan=\"2\"\u003e\n \u003cp\u003eCA-199,n(%)（＜27U/ml）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.604569420035148%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.364\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.646748681898067%\" colspan=\"2\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.604569420035148%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e21（53.85）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e14（46.67）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.646748681898067%\" colspan=\"2\"\u003e\n \u003cp\u003eWorse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.604569420035148%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e18（46.15）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e16（53.33）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ePatient baseline characteristics in the PC and PC-LGR groups. Fisher\u0026rsquo;s exact test was used as an alternative to Chi-square test when the number in one of the cells is smaller than 5. PC palliative chemotherapy. PC-LGR palliative chemotherapy combined with local radical gastrectomy.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2 Chemotherapy-related factors\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"454\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.835164835164836%\"\u003e\n \u003cp\u003ePC，N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003ePC-LRG，N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.835164835164836%\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.89010989010989%\" colspan=\"2\"\u003e\n \u003cp\u003echemotherapy regimen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003e0.951\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003ePlatinum + FU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.835164835164836%\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003eTaxane + FU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.835164835164836%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003ePlatinum+ Taxane + FU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.835164835164836%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.835164835164836%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003eChemotherapy cycle（median）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.835164835164836%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003ep＜0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.94505494505495%\" colspan=\"3\"\u003e\n \u003cp\u003eadverse reactions related to chemotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003e1-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.835164835164836%\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003e3-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.835164835164836%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003eChange of chemotherapy regimen（Average cycle）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.835164835164836%\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003e7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003ePreop.response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.835164835164836%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003eLocal region\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.835164835164836%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\" valign=\"top\"\u003e\n \u003cp\u003ep＝0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003ePR/SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.835164835164836%\" valign=\"top\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\" valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003ePD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.835164835164836%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003eMetastatic site\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.835164835164836%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\" valign=\"top\"\u003e\n \u003cp\u003ep＝0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003ePR/SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.835164835164836%\" valign=\"top\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\" valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003ePD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.835164835164836%\" valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.89010989010989%\" colspan=\"2\"\u003e\n \u003cp\u003eInitial imaging evaluation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\" valign=\"top\"\u003e\n \u003cp\u003e0.370\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003e\u0026le;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.835164835164836%\" valign=\"top\"\u003e\n \u003cp\u003e10（25.64）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\" valign=\"top\"\u003e\n \u003cp\u003e5（16.67）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.054945054945055%\"\u003e\n \u003cp\u003e＞3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.835164835164836%\" valign=\"top\"\u003e\n \u003cp\u003e29（74.36）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\" valign=\"top\"\u003e\n \u003cp\u003e25（83.33）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.054945054945055%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eComparison of chemotherapy-related parameters between PC group and PC-LRG group.Fisher\u0026rsquo;s exact test was used as an alternative to Chi-square test when the number in one of the cells is smaller than 5. PC palliative chemotherapy. PC-LGR palliative chemotherapy combined with local radical gastrectomy.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3 Cox proportional hazard model of overall survival\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003ePrognostic factor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003eUnivariate\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHR (95% CI)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003eMultivariate\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHR (95% CI)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e＜0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003eChemotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003eSurgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e0.371（0.222-0.620）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e0.349\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e0.763（0.438-1.329）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003eAge（years）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e0.696\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003e\u0026le;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003e＞60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e1.1（0.681-1.778）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003ecT-stage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e0.580\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003eT3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003eT4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e0.818（0.402-1.666）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.098591549295776%\" colspan=\"2\"\u003e\n \u003cp\u003eType of distant metastasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e0.952\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003ePeritoneal carcinomatosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003eLiver metastasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e1.033（0.593-1.795）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003eDistant LN metastasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e1.106（0.590-2.076）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003eCEA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e0.448\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003eWorse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e1.209（0.746-1.961）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003eCA-199\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e0.757\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003eWorse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e1.079（0.667-1.744）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003eInitial imaging evaluation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e0.849\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003e\u0026le;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003e＞3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e0.001（0.0001-8.818）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.098591549295776%\" colspan=\"2\"\u003e\n \u003cp\u003echemotherapy regimen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e0.642\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003ePlatinum + FU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003eTaxane + FU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e0.816（0.430-1.551）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003ePlatinum+ Taxane + FU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e0.697（0.382-1.270）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e1.035（0.452-2.370）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.098591549295776%\" colspan=\"2\"\u003e\n \u003cp\u003eChemotherapy cycle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e＜0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003e\u0026le;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003e＞7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\"\u003e\n \u003cp\u003e0.304（0.181-0.511）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.978873239436616%\" colspan=\"3\"\u003e\n \u003cp\u003eAdverse reaction to chemotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e0.322\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003e\u0026le;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\" valign=\"top\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003e＞2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\" valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\" valign=\"top\"\u003e\n \u003cp\u003e0.746（0.418-1.331）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.978873239436616%\" colspan=\"3\"\u003e\n \u003cp\u003eChange of chemotherapy regimen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e＜0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e0.994\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003e\u0026le;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\" valign=\"top\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003e＞5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\" valign=\"top\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\" valign=\"top\"\u003e\n \u003cp\u003e0.344（0.206-0.574）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003ePreop.response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003eLocal region\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003ePR/SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\" valign=\"top\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003ePD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\" valign=\"top\"\u003e\n \u003cp\u003e0.980（0.001-2.77）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003eMetastatic site\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003ePR/SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\" valign=\"top\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.774647887323944%\"\u003e\n \u003cp\u003ePD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\" valign=\"top\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.880281690140844%\" valign=\"top\"\u003e\n \u003cp\u003e1.405（0.01-3.640）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.190140845070424%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;the final model was selected by a forward likelihood ratio method from the variables with p-value \u0026lt; 0.10 in a univariate Cox proportional hazard model The bold represents statistical significance\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 4 \u0026nbsp;Cox proportional hazard model of overall survival for Group2\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003ePrognostic factor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\"\u003e\n \u003cp\u003eUnivariate\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHR (95% CI)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\"\u003e\n \u003cp\u003eMultivariate\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHR (95% CI)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003eASA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\"\u003e\n \u003cp\u003e0.586\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003eI-II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\"\u003e\n \u003cp\u003e0.814（0.390-1.701）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.6530612244898%\" colspan=\"2\"\u003e\n \u003cp\u003ePreoperative chemotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.832\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026le;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e＞3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\" valign=\"top\"\u003e\n \u003cp\u003e1.087（0.503-2.351）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.6530612244898%\" colspan=\"2\"\u003e\n \u003cp\u003ePostoperative chemotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e＜0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\" valign=\"top\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026le;6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e＞6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\" valign=\"top\"\u003e\n \u003cp\u003e0.150（0.053-0.428）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.6530612244898%\" colspan=\"2\"\u003e\n \u003cp\u003ePostop recovery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026ge;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\" valign=\"top\"\u003e\n \u003cp\u003e1.884（0.877-4.047）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003ePostop days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e0.280\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e＜10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026ge;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\" valign=\"top\"\u003e\n \u003cp\u003e1.580（0.705-3.540）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.6530612244898%\" colspan=\"2\"\u003e\n \u003cp\u003ePreoperative CEA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003eImprove\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003eStable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\" valign=\"top\"\u003e\n \u003cp\u003e0.894（0.395-2.020）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003eWorse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\" valign=\"top\"\u003e\n \u003cp\u003e2.369（0.814-6.892）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e1-3moth CEA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\" valign=\"top\"\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003eImprove\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003eStable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\" valign=\"top\"\u003e\n \u003cp\u003e0.831（0.106-6.520）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003eWorse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\" valign=\"top\"\u003e\n \u003cp\u003e4.290（0.538-34.173）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.6530612244898%\" colspan=\"2\"\u003e\n \u003cp\u003ePreoperative CA-199\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003eImprove\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003eStable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\" valign=\"top\"\u003e\n \u003cp\u003e1.004（0.429-2.350）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003eWorse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\" valign=\"top\"\u003e\n \u003cp\u003e2.878（1.054-7.860）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.6530612244898%\" colspan=\"2\"\u003e\n \u003cp\u003e1-3moth CA-199\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\" valign=\"top\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003eImprove\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003eStable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\" valign=\"top\"\u003e\n \u003cp\u003e0.296（0.073-1.199）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003eWorse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\" valign=\"top\"\u003e\n \u003cp\u003e3.004（0.778-11.591）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.6530612244898%\" colspan=\"2\"\u003e\n \u003cp\u003eType of operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.371\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003eTG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003eDG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\" valign=\"top\"\u003e\n \u003cp\u003e1.425(0.646-3.142)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003eyPT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e0.236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026le;T3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003eT4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\" valign=\"top\"\u003e\n \u003cp\u003e1.565（0.747-3.278）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003eyPN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e0.158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003eN0-N1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003eN2-N3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.8659793814433%\" valign=\"top\"\u003e\n \u003cp\u003e1.752（0.790-3.883）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ethe final model was selected by a forward likelihood ratio method from the variables with p-value \u0026lt; 0.10 in a univariate Cox proportional hazard model The bold represents statistical significance\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"advanced gastric, gastrectomy, palliative chemotherapy ","lastPublishedDoi":"10.21203/rs.3.rs-4565544/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4565544/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"There are limited studies on the treatment of patients with advanced gastric cancer with a single non-curable factor by palliative chemotherapy (PC) combined with local radical gastrectomy (LRG).In this study, our aim is to analyze the effectiveness and safety of palliative chemotherapy combined with local radical gastrectomy(PC-LRG)for patients with advanced gastric cancer with a single non-resectable factor. We retrospectively analyzed the patients with advanced gastric cancer with a single unresectable factor who received first-line chemotherapy in Fujian Provincial Hospital from January 2017 to June 2023. In total, 69 consecutive patients were enrolled into the PC(39 patients) and LRG-PC (30 patients) group. The primary research endpoint is the overall survival (OS) of patients in both groups, and the secondary research endpoint is the time of resistance to the first-line chemotherapy protocol.The OS of the PC-LGR group (20.0 VS 10.0 months, P\u003c0.0001) and the time for changing the first-line chemotherapy plan (7.5 VS 3.2 cycles, p\u003c0.05) were significantly better. There was statistical significance between the average total number of chemotherapy cycles of the two groups (8.7 VS 6.1, p\u003c0.05). The incidence of grade III or higher adverse reactions to chemotherapy in the PC group (12.8% VS 33.3%, p=0.41) was better than that in the PC-LGR group.For patients with advanced gastric cancer who have a single non-reversible factor, PC-LGR may reduce tumor burden, improve tolerance to chemotherapy drugs, and prolong the OS of patients.","manuscriptTitle":"Prognosis analysis of palliative chemotherapy combined with radical local gastric surgery for advanced gastric cancer patients with single non-curable factor","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-16 20:21:49","doi":"10.21203/rs.3.rs-4565544/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e6fe49c9-97cb-489a-84cf-9453a671d9a4","owner":[],"postedDate":"July 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-07T19:24:47+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-16 20:21:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4565544","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4565544","identity":"rs-4565544","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}