| objective: to observe the effect of neoadjuvant chemotherapy on short-term clinical outcome and long-term prognosis of locally advanced gastric cancer.To explore the basis of neoadjuvant chemotherapy in improving the clinical outcome of patients with locally advanced gastric cancer.Methods: a retrospective case-control study was conducted.Patients with locally advanced gastric cancer who were treated in the affiliated Hospital of Qingdao University from January 2011 to January 2017 were divided into trial group and control group according to their preoperative clinical stage.The trial group received neoadjuvant chemotherapy before operation,the control group received surgery directly,88 patients in each group,and both groups received adjuvant chemotherapy after operation.The observation indexes were as follows:(1)the short-term clinical outcomes(incidence of postoperative complications,postoperative fever time,postoperative exhaust defecation time and postoperative hospitalization days,etc.)were compared between the two groups.(2)the long-term prognosis(3-year overall survival rate,OS and 3-year disease-free survival rate,DFS)were compared between the two groups.Cox multivariate regression was used to analyze the survival of the two groups.(3)to analyze the surgical conditions and oncology related indexes of the two groups.Result:1.The incidence of postoperative complications(36.36% vs.18.18%,P=0.007)、the length of hospital stay(days)(12.34 vs.9.33,P=0.003)、postoperative exsufflation time(days)(4.52 ±2.14 vs.3.76 ±1.15,P< 0.004)、postoperative defecation time(days)(6.45±2.08 5.90 ±1.10,P= 0.030)、postoperative fever time(3.18 ±4.26 vs.1.43 ±1.466,P <0.001)in the trial group were significantly higher than those in the control group(P <0.05).2.The 3-year overall survival rate(OS)of the trial group was significantly higher than that of the control group(64.00% vs.43.40%,P< 0.020)and the 3-year disease-free survival rate of(DFS)(was 62.00% vs.41.5%,P≤ 0.023)was also significantly higher than that of the control group by Kaplan-Meier method.COX multivariate survival analysis showed that neoadjuvant chemotherapy was not only an independent risk factor (HR=0.504,P=0.038)to 3-year OS,but also an independent risk factor(HR=0.504,P=0.032)to 3-year DFS.In the trial group,the overall survival rate was 66.70%(SOX)vs.60.90%(XELOX)for patients with different chemotherapy regimen.In the control group,the overall survival rates of the two chemotherapy regimens were 46.70%(SOX)amd44.40%(XELOX)respectively.3.The rate of R0 resection in the trial group was higher than that of the control group(79% vs.71%,P=0.095),the number of lymph node detection in the trial group was significantly lower than that in the control group(28.17 ±14.57 vs.34.11 ±15.66,P ≤0.011).The number of cases of combined organ resection(5 vs.16,P < 0 001)in the trial group was significantly lower than that in the control group.The number of positive lymphoid nodes(4.60 ±5.93 vs.17.29 ±13.03,P< 0.001)、nerve infiltration(42 vs.67,P <0.001),vascular invasion(27 vs.56,P < 0.001)、the tumor length diameter(cm)(4.93±2.78 vs.6.28 ±2.76,P= 0.002)in the trial group were smaller than that in the control group.4.The efficacy of neoadjuvant chemotherapy showed that the objective remission rate of(orr)was 47.73% according to RECIST 1.1 standard and 56.81% was descended stage in pathological according to the TRG grade.Conclusions:Neoadjuvant chemotherapy had a negative effect on the short-term clinical outcome,neoadjuvant chemotherapy could increased the rate of R0 resection and improved long-term prognosis of locally advanced gastric cancer. |
PDF Full Text Request