Neoadjuvant intra-arterial chemoembolization improves tumor pathological regression and survival in Borrmann type IV gastric cancer

Figure 1 Flow chart of Borrmann type IV gastric cancer patient selection. IAC: Intra-arterial chemoembolization.

Figure 2 Kaplan-Meier curves of survival outcomes for all Borrmann type IV gastric cancer patients. A: Overall survival; B: Disease-free survival.

Figure 3 Kaplan-Meier curves of survival outcomes stratified by pathological response. A: Overall survival in the responder vs non-responder group; B: Disease-free survival in the responder vs non-responder group. OS: Overall survival; DFS: Disease-free survival; CR: Complete response; PR: Partial response; SD: Stable disease; PD: Progressive disease.

Figure 4 Kaplan-Meier curves of overall survival and disease-free survival according to N-stage regression. A: Overall survival; B: Disease-free survival. Patients with N-stage regression had longer overall survival and disease-free survival than patients without N-stage regression (both log-rank P < 0.001). Vertical plus signs indicate censored observations. OS: Overall survival; DFS: Disease-free survival; N-reg (+): Positive N-stage regression; N-reg (-): Negative N-stage regression.

Figure 5 Schematic illustration of the tumor microenvironment remodeling induced by neoadjuvant intra-arterial chemoembolization in Borrmann type IV gastric cancer. A: Pre-treatment immunosuppressive “cold” microenvironment. The tumor is characterized by an abundance of fibroblasts and a dense desmoplastic stroma, which acts as a formidable physical barrier preventing the infiltration of cytotoxic immune cells, such as CD8+ T cells and natural killer cells, restricting them to the tumor periphery; B: Post-treatment inflamed “hot” microenvironment. The localized, high-concentration delivery of oxaliplatin combined with lipiodol-induced embolic ischemia effectively disrupts the stromal barrier. This dual mechanism triggers massive immunogenic cell death and necrosis of the cancer cells, subsequently facilitating the robust, deep infiltration of CD8+ T cells and natural killer cells into the tumor core. NK: Natural killer.