# Impact of total gastrectomy plus perioperative PD-1 inhibitors on survival in locally advanced gastric cancer

## TL;DR

Adding the PD-1 inhibitor sintilimab to standard treatment for advanced stomach cancer improves survival and surgical outcomes without increasing severe side effects.

## Contribution

Demonstrates that combining sintilimab with surgery and chemotherapy improves survival and surgical outcomes in locally advanced gastric cancer.

## Key findings

- Patients receiving sintilimab had higher R0 resection, pCR, and MPR rates compared to controls.
- The experimental group showed significantly better 3-year OS and DFS compared to the control group.
- Adverse events were comparable between groups, with manageable immune-related side effects in the experimental group.

## Abstract

The prognosis for locally advanced gastric cancer (LAGC) remains suboptimal with standard perioperative chemotherapy. Integrating PD-1 inhibitors into this regimen is a promising strategy requiring further validation.

To evaluate the efficacy and safety of total gastrectomy plus perioperative PD-1 inhibitor (Sintilimab) in the management of locally advanced gastric cancer (LAGC).

In this retrospective cohort study, 200 patients with LAGC undergoing total gastrectomy (January 2021 - November 2022) were categorized based on treatment received into an experimental group (perioperative sintilimab + XELOX, n=100) and a control group (perioperative XELOX alone, n=100).

The experimental group demonstrated the markedly higher rates of R0 resection rate (97%: 90%, P < 0.05), pCR (25%: 10%, P < 0.05), and MPR (35%: 20%, P < 0.05) as opposed to the control group. Survival analysis revealed significantly better outcomes in the experimental group: 3-year OS (48%: 30%, P = 0.009), median OS (34.7: 23.6 months, P = 0.004), 3-year DFS (40%: 25%, P = 0.001), and median DFS (30.4: 21.3 months, P = 0.007) Two groups showed no clinically relevant difference in the frequency of grade ≥3 therapy-related adverse events (56.0%: 51.0%, P > 0.05). Immune-related adverse outcomes in the experimental group were mainly grade 1–2 hypothyroidism and rash, which were relieved after symptomatic treatment.

Total gastrectomy combined with perioperative sintilimab +XELOX regimen for LAGC significantly improves radical surgery, pathological response rate and long-term survival, with a manageable safety profile, offering a potentially effective treatment strategy.