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

Objective: To compare the efficacy and safety of TPF versus FOLFOX regimens in conversion therapy for locally unresectable advanced gastric cancer (LAUGC) and to identify prognostic factors influencing clinical outcomes.

Methods: This retrospective study analyzed 264 LAUGC patients treated with either TPF (n=140) or FOLFOX (n=124) between 2019 and 2021. Primary endpoints were objective response rate (ORR) and 1-year survival; secondary endpoints included conversion surgery rate, toxicity, and 3-year survival. Prognostic factors were evaluated using multivariate Cox regression and time-dependent ROC analyses.

Results: The TPF group demonstrated significantly higher ORR (P=0.01) and disease control rate (DCR; P<0.001) compared to the FOLFOX group. Rates of conversion surgery (P=0.011) and R0 resection (P=0.003) were also improved. One-year survival was superior in the TPF cohort (P<0.05), whereas 3-year survival rates showed no significant difference (P>0.05). Although myelosuppression was more frequent with TPF (P=0.002), the incidence of severe adverse events was comparable between groups. Multivariate analysis identified FOLFOX regimen, elevated carcinoembryonic antigen (CEA), and N3 stage as risk factors for 1-year mortality, while higher albumin levels and lymphocyte counts were protective. Tumor size ≥5 cm and poor differentiation were associated with increased 3-year mortality risk. Albumin demonstrated strong predictive value for 1-year survival.

Conclusion: The TPF regimen can effectively improve the objective response rate and short-term survival in LAUGC patients undergoing conversion therapy, with manageable myelosuppression. The analysis of prognostic risk factors facilitates individualized treatment strategies.