Retrospective Cohort Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2025; 17(3): 94286
Published online Mar 27, 2025. doi: 10.4240/wjgs.v17.i3.94286
Efficacy of fluorouracil combined with paclitaxel and oxaliplatin for the treatment of advanced gastric signet ring cell carcinoma
Mi Liu, Bei Feng, Na He, Rong Yan, Jie Qin
Mi Liu, Department of Gastroenterology, The First Affiliated Hospital of Xi’an Medical University, Xi’an 710077, Shaanxi Province, China
Bei Feng, Department of Oncology, The Affiliated Hospital of Yan’an University, Yan’an 716000, Shaanxi Province, China
Na He, Rong Yan, Jie Qin, Department of Gastroenterology, The First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, Shaanxi Province, China
Author contributions: Qin J designed the study; Liu M wrote the original draft; Feng B, He N, and Yan R collected the raw data; Yan R performed the statistical and bioinformatics analyses; Qin J supervised the study; All authors have read and approved the final version of the manuscript.
Institutional review board statement: The Ethics Committee of the First Affiliated Hospital of Xi'an Medical University approved the study, No. XYYFYLL-KTSB-2024-10.
Informed consent statement: All patients obtained written informed consent.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: The data used to support this study are available from the corresponding author upon request at qinjie202202@163.com.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work Non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is Non-Commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jie Qin, Department of Gastroenterology, The First Affiliated Hospital of Xi'an Medical University, No. 48 Fenghao West Road, Lianhu District, Xi'an 710077, Shaanxi Province, China. qinjie202202@163.com
Received: March 14, 2024
Revised: September 17, 2024
Accepted: December 25, 2024
Published online: March 27, 2025
Processing time: 346 Days and 14.6 Hours
Abstract
BACKGROUND

Gastric signet ring cell carcinoma (GSRC) is a distinctive type of gastric cancer. It is a mucus-secreting adenocarcinoma that may progress to distant metastasis at an early stage. Because of poor differentiation, aggressive invasion, rapid progression, and other high-risk characteristics, early surgical intervention should be prioritized.

AIM

To explore the clinical efficacy of fluorouracil (5-FU) combined with paclitaxel and oxaliplatin for the treatment of advanced GSRC.

METHODS

A total of 85 patients with advanced GSRC were selected between January 2020 and June 2021 and randomly divided into a control group (n = 42, receiving standard chemotherapy) and a treatment group (n = 43, receiving monotherapy with oxaliplatin, 5-FU, and paclitaxel). Patients in the treatment group received a 135 mg/m2 infusion of paclitaxel for 3 hours, a 400 mg/m2 infusion of calcium folate (or 200 mg/m2 of levocalcium folate) for 2 hours, and an 85 mg/m2 infusion of oxaliplatin for 2 hours. This was followed by a continuous intravenous infusion of 2200-2400 mg/m2 5-FU for 46 hours using a portable pump.

RESULTS

The treatment group showed a median survival time of 11.7 months and an objective response rate (ORR) of 32.5%, significantly higher than the control group (P < 0.05). Serum carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and albumin levels were correlated with treatment effectiveness in advanced GSRC (P < 0.01), but total serum protein was not correlated (P > 0.05). Safety and survival were assessed in all patients. Short-term efficacy was evaluated in 66 patients, with a disease control rate of 89.4% and an ORR of 48.5%. Median progression-free survival was 7.0 months (95% confidence interval [CI]: 6.85-7.15), and median overall survival was 10.6 months (95%CI: 9.86-11.3). Primary grade III/IV adverse events included neutropenia (22.1%) and peripheral neurotoxicity (10.3%).

CONCLUSION

This treatment regimen is more effective for patients with advanced GSRC. Serum levels of CEA, CA19-9, and albumin predicted chemotherapy efficacy, while total protein concentration correlated minimally and insignificantly.

Keywords: Oxaliplatin; Tigio; Carcinoembryonic antigen; Carbohydrate antigen 19-9; Advanced gastric signet ring cell carcinoma

Core Tip: This study explored the clinical efficacy of fluorouracil combined with paclitaxel and oxaliplatin for the treatment of patients with advanced gastric signet ring cell carcinoma, and analyzed the role of serum carcinoembryonic antigen, carbohydrate antigen 19-9, albumin, and total protein levels in evaluating chemotherapy efficacy.