Evaluation The Efficacy Of Neoadjuvant Chemotherapy And Adjuvant Chemotherapy For Gastric Cancer Treated With Surgery

Purpose:To compare the efficacy of neoadjuvant chemotherapy and adjuvant chemotherapy fot patients with gastric cancer treated with surgery and its correlation with clinicopathological factors.Patients and methods:We retrospectively analyzed 194 patients with gastric treated by surgery from November 2012 to May 2016 in the second affiliated hospital of zhejiang university.Patients were divided into neoadjuvant chemotherapy group(n=85)and adjuvant group(n=109)according to the treatment pattern they received.According to 8th AJCC cance staging manual Stage I+II,III and IV diseases in neoadjuvant group and adjuvant group were 14 cases(16.6%)vs 30 cases(27.5%),60 cases(71.4%)vs 76 cases(69.7%);10 cases(11.9%)vs 3 cases(2.8%)respectively.All the 85 patients in the neoadjuvant group received neoadjuvant chemotherapy plus surgical treatment,and continued the same chemotherapy regimen for 3 cycles postoperatively as before.All 109 patients in the adjuvant group received surgery plus postoperative adjuvant chemotherapy for at least 3 cycles.Further analysis was performed after dividing patients into different group according to clinical and pathological features.ResultsThere was no significant difference in OS between neoadjuvant group and adjuvant group,P=0.059,the 1-year,2-year,3-year survival rates was 80.0%VS 90.8%(P=0.024);62.2%VS 76%(P=0.022),55.5%vs 64%(P=0.17),respectively.The OS of patients with stage Ⅰ+Ⅱ disease also didn’t show statistical difference between neoadjuvant group and adjuvant group(p=0.886),the 1-year,2-year,3-year survival rate was 92.9%vs 92.9%(P=1),85.7%vs88.4%(P=0.978),85.7%vs88.4%(P=0.978).No survival significant difference was found comparing neoadjuvant group with adjuvant group for patients with stage Ⅲ disease P=0.218,the 1-year,2-year,3-year survival rate was 80.0%vs 89.5%(P=0.123),61.6%vs 71.5%(P=0.237),52.0%vs 61.8%(P=0.326).There was no significant difference in overall survival between the neoadjuvant group and the adjuvant group in stage IV patients P=0.691,however,3-year survival of neoadjuvant group was higher than that of adjuvant group 40%VS 0%(P=0.01).There was no significant difference in the overall survival rate between the neoadjuvant group and the adjuvant group at the T1-2 stage.There was also no significant difference in overall survival between the neoadjuvant group and the adjuvant group at T3-4 stage.Stratified according to the number of lymph node metastases,no significant difference was found between the neoadjuvant group and the adjuvant group in N0-1 stage.The N2-3stage of neoadjuvant group had worse overall survival than the adjuvant group P=0.028 the 1-year,2-year,3-year survival rate was 72.4%VS87.3%(P=0.105),51.7%VS69.1%(P=0.112),43.1%vs 65.6%(P=0.049),respectively.The 3-year survival rate in the neoadjuvant group was significantly lower than that in the adjuvant group.According to the presence or absence of distant metastasis,there was no significant difference between the neoadjuvant group and the adjuvant group in overall survival in M0 stage(P=0.155),and no significant difference in M1 stage(P=0.448).According to the stratification of tumor differentiation,there was no significant difference in the overall survival rate in the neoadjuvant group and adjuvant group when stratified into differentiated group and undifferentiated group.According to LAUREN classification and stratification,the overall survival rate of patients in the neoadjuvant group with diffuse type was lower than that in the adjuvant group(P=0.027).The 1-year,2-year and 3-year survival rates were 70.0%vs.89.3%(P=0.078),49.8%vs.72.1%(P=0.048),and 39.3%vs.60.7%(0.103),respectively.There was no significant difference in the overall survival rate between the neoadjuvant group and the adjuvant group in the intestinal type and the mixed type.The neoadjuvant group was grouped according to chemotherapy response.According to RECIST criteria,although the overall survival rate of CR+PR group was not significantly different from that of PD+SD group(P=0.088),the 1-year,2-year,and 3-year survival rates were 86.1%vs.77.1%(P=0.284),75%vs.53.9%(P=0.03),and 66.1%vs.48.7%(P=0.129),the 2-year survival rate of CR+PR group was significantly better than that of PD+SD group(P=0.129).According to BECKER stage the overall survival rate of grade 1 and grade 2 was better than that of grade 3,P=0.033,with 87.2%vs.73.9%(P=0.116),76.8%vs.50%(P=0.006),and 67.8%vs45%(P=0.045),respectively.The overall survival rate was higher in RECIST with CR+PR and BECKER level 1+2 than in RECIST with PD+SD and BECKER level 3,P=0.024.The 1,2,and 3-year survival rates were 88.2%vs.69.2%(P=0.113),82.4%vs.38.5%(P=0.0009),and 68.6%vs.33.7%(P=0.021),respectively.Conclusion1)There was no significant difference in the efficacy between neoadjuvant chemotherapy and adjuvant chemotherapy in stage II and III patients.2)Stage IV patients may benefit from neoadjuvant chemotherapy.3)For patients with diffuse type disease neoadjuvant chemotherapy is less effective than adjuvant chemotherapy.4)Integrating RECIST standard and BECKER rating can better predict the prognosis of neoadjuvant chemotherapy patients.