A Prospective Cohort Study on the Treatment of Locally Advanced Gastric Cancer

Inclusion Criteria:

• Patients with newly diagnosed Her-2 negative gastric adenocarcinoma, with no priorchemotherapy, radiotherapy, or other anti-cancer treatments before the start of theclinical trial.

• Age between 18 to 80 years old, Eastern Cooperative Oncology Group (ECOG)performance status: 0-1.

• Staging according to the American Joint Committee on Cancer (AJCC) 8th edition isT4aNxM0, without obstruction, perforation, or bleeding risk.

• Good bone marrow reserve function, with the following blood criteria: white bloodcell count ≥3×10^9/L, neutrophils ≥1.5×10^9/L, platelet count ≥100×10^9/L,hemoglobin ≥90 g/L.

• Good organ function, with the following biochemical criteria: aspartateaminotransferase (AST) ≤2.5×upper limit of normal (ULN), alanine aminotransferase (ALT) ≤2.5×ULN, serum total bilirubin ≤1.5×ULN, serum creatinine ≤1.5×ULN orcreatinine clearance ≥50 mL/min.

• International normalized ratio (INR) ≤1.5, prothrombin time (PT) and activatedpartial thromboplastin time (APTT) ≤1.5 times ULN.

• Urine protein <2+, if urine protein ≥2+ then 24-hour urine protein quantificationmust be ≤1g.

• Consent to provide blood and tissue samples.

• Expected survival of more than 3 months.

• Female subjects agree to strict contraception; male subjects with partners ofchildbearing potential agree to use effective contraception during the study period.

• Voluntarily sign the informed consent form, willing and able to comply with plannedvisits, study treatments, laboratory tests, and other trial procedures.

Exclusion Criteria:

• Participants who have been enrolled in any other drug clinical trial or haveparticipated in any drug clinical trial within the last month.

• Any anti-cancer treatments (chemotherapy, radiotherapy, surgery, immunotherapy,biotherapy, chemoembolization) other than the study medication (palliative externalbeam radiation for non-target lesions is allowed).

• Prior use of similar chemotherapy drugs or immune checkpoint inhibitors.

• Presence of metastatic lesions in the liver, lungs, para-aortic lymph nodes, bones,brain, adrenal glands, or pelvic and abdominal cavity.

• Gastrointestinal perforation, obstruction, or uncontrollable diarrhea within 6months prior to enrollment.

• Other untreated or concurrent tumors, except for cervical carcinoma in situ, treatedbasal cell carcinoma, or superficial bladder tumors. Patients with tumors that havebeen cured and have no evidence of disease for more than 5 years may be included.All other tumors must have been treated at least 5 years prior to enrollment.

• Symptomatic meningiomas：

• History of active autoimmune diseases or refractory autoimmune diseases.

• Received corticosteroids (>10mg/day prednisone or equivalent dose of steroids) orother systemic immunosuppressive therapy within 14 days prior to enrollment,excluding the following treatments: steroid hormone replacement therapy (≤10mg/day);local steroid therapy; and short-term prophylactic steroid therapy for allergies ornausea and vomiting.

• History of HIV infection or active hepatitis B/C virus infection.

• Persistent > Grade 2 bacterial, fungal, viral infections.

• Active or clinically significant cardiac disease:

• Congestive heart failure > New York Heart Association (NYHA) Class II;

• Active coronary artery disease;

• Arrhythmias requiring treatment other than beta-blockers or digoxin;

• Unstable angina (angina symptoms at rest), new-onset angina within 3 months prior toenrollment, or unhealed wounds, ulcers, or fractures due to myocardial infarctionwithin 6 months prior to enrollment.

• Patients with renal failure requiring hemodialysis or peritoneal dialysis.

• Patients requiring medication for epilepsy.

• History of organ transplantation (including corneal transplants).

• Allergy to the study medication or similar drugs, or suspected allergies.

• Pregnant or breastfeeding women.

• Major surgery, open biopsy, or significant traumatic surgery within 4 weeks prior torecruitment.

• History of vaccination within 4 weeks prior to enrollment.

• Patients deemed unsuitable for the study by the investigator.