| Objective: To observe and study the clinical outcomes of adjuvant chemotherapy combined with synchronous radiotherapy after radical therapy in progressive gastric cancer(GC)with indeterminate lymph nodes(LNs)clearance,and discuss the prognostic factors.To provide a reference for clinical selection of postoperative adjuvant therapy.Methods: A retrospective analysis of 231 patients,who were admitted to our hospital and Department of Gastrointestinal Surgery,Affiliated Hospital of Guizhou Medical University from January 2012 to December2017 after radical treatment for GC with indeterminate LNs clearance(using D2 radical treatment for GC,the pathology describes lymph node clearance range is less than D2),was divided into 109 cases in the chemotherapy group(control group)and122 cases in the radiotherapy group(observation group)according to adjuvant treatment.Both groups completed 4 to 8 cycles of systemic chemotherapy with oxaliplatin in combination with fluorouracil(oxaliplatin with 5-fluorouracil or capecitabine or tegio),while the observation group was given anastomosis plus lymphatic drainage zone radiation therapy after 1-2 cycles of chemotherapy at a dose of 45-50.4Gy/25-28 times/5-6 weeks,and fluorouracil chemotherapy alone was administered to sensitize patients during radiation therapy,then 3-6 cycles of adjuvant chemotherapy should be completed at the end of concurrent radiation therapy.The3-year overall survival(OS)and 3-year disease-free survival(DFS)rates,local recurrence rates,distant metastasis rates,and adverse events rates of the two groups were analyzed in comparison,apart from this,the 3-year OS and 3-year DFS rates of stage II,stage III,and regional lymph node positive patients were further analyzed.Results: 1.The 3-year OS was 66.3% and 55.9%;the 3-year DFS was56.1% and 40.8%;According to the scientific analysis,there was no statisticaldifference in the 3-year OS between the two groups(P = 0.067),and the difference in3-year DFS between the two groups was statistically significant(P = 0.019);2.The3-year OS of the patients in the observation group and the control group was respectively 97.9 % and 94.0%;3-year DFS were 91.1% and 91.2%;the two groups of the 3-year OS and 3-year DFS had no statistical difference(both P> 0.05);The3-year OS of the observation group and the control group patients was respectively45.9% and 36.7%;the 3-year DFS was 33.6% and 14.4%;the 3-year OS of the two groups was not statistically significant(P = 0.112),the 3-year DFS difference between the two groups was statistically significant(P = 0.018);3.The 3-year OS of the lymph node positive patients in the observation group and the control group was61.2% and 48.1%,respectively,and the 3-year DFS was 51.3%,and 31.1%,respectively;after statistical analysis,the difference in 3-year OS and 3-year DFS between the two groups was statistically significant(both P <0.05);4.The local recurrence rate of observation group and control group was respectively 18.9%,31.2%,distant metastasis rates,30.3% and 32.1% respectively;the difference in local recurrence rate between the two groups was statistically significant(P = 0.037);the difference between the two groups in distant metastasis rate was not statistically significant(P = 0.835);5.The toxic side effects of the two groups were mainly manifested as grade I-II hematological toxicity,gastrointestinal reactions,liver function damage,skin and mucosal reactions.The incidence rate of grade III-IV toxic side reactions was relatively low,and the difference in toxic side effects between the two groups was not statistically significant.6.Analysis of prognostic factors: The total TNM stage,N staging and the number of completed chemotherapy cycles have a significant correlation with the prognosis of patients.Multi-factor COX regression analysis results showed that postoperative adjuvant radiochemotherapy significantly reduced the risk of advanced gastric cancer death and improved survival compared with chemotherapy alone.Conclusion: This topic studys GC patients with indeterminate LNs clearance,and postoperative adjuvant chemotherapy combined with synchronous radiotherapy which did not significantly prolong 3-year OS compared with adjuvant chemotherapy alone,but it could improve 3-year DFS andreduce local recurrence;radiotherapy could improve 3-year DFS in stage III patients;The addition of radiotherapy will improve patients with positive postoperative pathological lymph nodes 3-year OS and 3-year DFS,in the meantime the toxic side effects could be tolerated.Multi-factor COX regression analysis results showed that postoperative adjuvant radiochemotherapy significantly reduced the risk of advanced gastric cancer death and improved survival compared with chemotherapy alone,especially in patients with postoperative pathological lymph node positive. |
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