PMC8727688_01
(A) In the excised specimen of gastric tumor, a hard region of 5x7cm was observed 6cm from the distal margin. (B) The retinal tissue excised during the operation was 25x13x1.5cm in size. (C-E) Hematoxylin and eosin staining suggested poorly differentiated adenocarcinoma, infiltrating the whole gastric wall (T3), carcinoma infiltration in the nerve bundle, no tumor thrombus in the vascular, no cancer involvement in the distal resection margin, and no cancer metastasis in the omentum tissue. The lymph nodes in the greater curvature of the stomach showed cancer metastasis. (F) Programmed cell death ligand 1 (PD-L1) staining was negative.
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The final histopathology was that of a poorly differentiated adenocarcinoma with lymph node metastases (stage pT3N2) ( Figure 1 ). During the treatment, we tested the original stomach tumor again and the result was negative for PDL-1 ( Figure 1 ).
PET-CT and follow-up CT images. Arrows indicate tumors. (A) After the patient's tumor recurred, pre-treatment positron emission tomography (PET)-computed tomography (CT) scan suggested metastatic lesions in the right lower chest wall, invasion of the adjacent peritoneum, and hepatic S4 involvement. Multiple patchy and nodular metastases in peritoneum of abdomen and pelvis. (B) After camrelizumab combined with CAPOX for 6 courses, positron emission tomography (PET)-computed tomography (CT) scan showed that the original metastatic lesions on the right lower chest wall disappeared, and the original multiple metastatic lesions on the peritoneum disappeared. No new tumors were observed in other organs. (C-G) During the period of camrelizumab plus capecitabine as maintenance therapy, regular CT scans suggested that the condition was stable, the original tumor lesions disappeared, and no new tumor lesions were found.
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To date, her quality of life is good, no new tumors have been detected on regular contrast-enhanced CT ( Figure 2 ), and the symptom of right lower abdominal pain has disappeared completely(the NRS score was reduced from 8 to 0).
We closely followed the patient's tumor markers, but unfortunately there were no significant abnormalities and no specific changes in the patient's tumor markers during the onset and treatment.
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The tumor markers of the patient were closely observed, and the changes were shown in  Figure 3 .