Research On SOX Combined With Apatinib Neoadjuvant Protocol For Locally Advanced Gastric Cancer

BackgroundGastric cancer is a kind of gastrointestinal malignant tumor originated from gastric mucosal epithelium,which is mostly caused by dietary structure changes,helicobacter pylori infection,increased work pressure and other factors.Among the malignant tumors in China,the incidence of gastric cancer ranks the second and the death rate ranks the third.The 5-year survival rate of patients who receive operation in early phases could reach 90%or above.Due to the strong concealed nature of early gastric cancer,most patients are already in the middle and late stage when they are diagnosed,thus surgical treatment alone may not bring about satisfied effect.However,relevant studies have pointed out that neoadjuvant chemotherapy can reduce the pathological stages of gastric cancer and play an important role in improving tumor resection rate and prognosis of patients.ObjectiveBased on clinical practice experience,the effects of SOX combined with apatinib neoadjuvant treatment protocol for locally advanced gastric cancer will be discussed,and the efficacy and safety of the combined treatment protocol will be analyzed,so as to provide treatment options for locally advanced gastric cancer patients in future.MethodsA retrospective analysis was conducted on 94 patients with locally advanced gastric cancer who were admitted to our hospital from January 2016 to May 2017.Among these patients,50 of them were treated with SOX protocol combined with apatinib protocol as the combined group,and 44 patients were treated with SOX regimen alone(Tegafur Gimeracil Oteracil Potassium + oxaliplatin)as the SOX group.After three weeks of treatment,radical D2 resection was adopted as the preferred option for the abovementionedtwo groups of patients,and palliative resection or bypass operation of the digestive tract was performed if local cancer focus could not be radical resected,so as to improve the clinical symptoms of the patients.The comparisons of objective remission rate,disease control rate and surgical clearance rate among these two groups,the observation of KPS score of these patients before and after treatment,the comparison of levels of tumor markers and serum neovascularization markers of these patients before and after the treatment,the investigation of their quality of life during the period of survival,the observation of the adverse reaction of patients during their lifetime,and the observation of1 year or 2 year survival rate,the progression free survival time,and the median overall survival time of these two groups of patients with postoperative 2 year follow-up were made.ResultsThe objective remission rate(72.00%)and disease control rate(94.00)of the combined group is significantly higher than those of the SOX group(52.27%,79.55),and the difference(chi-square=9.362,10.214,P<0.05)has statistical significance.The surgical resection rate of the combined group was 92.00%,which is higher than that of the SOX group(70.45%),and the difference(chi-square =7.331,P< 0.05)has statistical significance.The 1-year and 2-year survival rates in the combined group is 84.00% and 70.00%,which is higher than those in the SOX group(65.91% and 47.73),and the difference(chi-2=4.145 and 4.821,P< 0.05)has statistical significance.Before treatment,there is no significant difference(t= 1.062,P>0.05)in KPS scores between these two groups;after treatment,KPS scores in both groups has been increased,and KPS scores in the combination group is higher than those in the SOX group,the difference(t=3.463,P<0.05)has statistical significance..The progression free survival time and median total survival time of the combination group are significantly longer than those of the control group,the differences have statistical significance(t=3.286,4.019,P<0.05).Before treatment,there is no significant difference in the levels of CEA,CA125 and CA199 between the two groups(P>0.05),while after treatment,the levels of CEA,CA125 and CA199 in the two groups are reduced,and the combination group shows a more obvious degree(P<0.05).After treatment,VEGF,Ang-2,ES and PEDF levels of the combined group is lower than those of the control group,the differences has statistical significance(P<0.05).The score of quality of life of the combined group is higher than that of the SOX group,and the pain index and emotion index are lower than that of the SOX group(P<0.05).When the incidence rate of toxic side effects of the combination group(22.00%)is compared with that of the SOX group(29.55%),the has no statistical significance(chi-square =4.293,P>0.05).ConclusionThe objective remission rate and disease control rate of the protocol that takes SOX combined with apatinib neoadjuvant treatment presents a positive result,improves the resection rate,prolongs survival time of patients with advanced gastric cancer,raises the level of tumor markers and the level of serum neovascularization markers of patients,and improves the patients’ quality of life,but it does not increase the risk of side effects,which is worth further research with larger sample size.