Prognostic Difference Between Perioperative Chemotherapy And Postoperative Adjuvant Chemotherapy Alone In Locally Advanced Gastric Cancer

Objective:To explore whether neoadjuvant chemotherapy combined with postoperative adjuvant chemotherapy can reduce recurrence and prolong survival compared with postoperative adjuvant chemotherapy alone in patients with locally advanced gastric cancer,and to study and analyze the prognostic factors of patients with gastric cancer.Methods: A total of 418 patients with locally advanced gastric cancer who met the inclusion criteria of this study from October 2014 to September 2016 were collected and divided into auxiliary group and neoauxiliary group.The clinicopathological data such as gender,age,clinical TNM stage,tumor location,Lauren classification,degree of differentiation,R0 resection,pathological T stage and pathological N stage of the enrolled patients were collected.The patients receiving perioperative chemotherapy and patients receiving simple postoperative adjuvant chemotherapy were matched 1:1by propensity score matching(PSM),The survival differences between perioperative chemotherapy and postoperative adjuvant chemotherapy alone were analyzed,and the safety of the two groups of chemotherapy modes was compared.At the same time,the efficacy of neoadjuvant chemotherapy group was evaluated.Finally,Cox multivariate analysis was carried out to analyze the independent prognostic factors of gastric cancer patients.Results:A total of 418 patients with gastric cancer were collected in this study,including 231 in the auxiliary group and 187 in the neoauxiliary group.After psm1:1matching,145 patients with adjuvant chemotherapy were matched with 145 patients with neoadjuvant chemotherapy.The results of survival analysis showed that after propensity score matching,the 5-year DFS of postoperative adjuvant chemotherapy patients and perioperative chemotherapy patients were 51.5% and 48.2%(P = 0.617),and the 5-year OS were 61.9% and 64.2%(P = 0.549),respectively.The results showed that there was no significant difference in 5-year survival rate between patients with postoperative adjuvant chemotherapy and patients with perioperative chemotherapy.In the neoadjuvant chemotherapy group,the efficacy of RECIST was evaluated.The results showed that there were 5 patients with CR(2.7%),74 patients with PR(39.6%),90 patients with SD(48.1%),18 patients with PD(9.6%),the objective remission rate(ORR)was 42.4%,and the disease control rate(DCR)was 88.0%.Histopathological evaluation was based on Becker criteria.The results showed that there were 34 cases(18.2%)in 1a + 1b,54 cases(29.0%)in grade 2 and 99 cases(53.0%)in grade 3.The main grade 3-4 treatment-related adverse reactions in the adjuvant group were leucopenia in 18 cases(7.8%),anemia in 16 cases(6.9%)and thrombocytopenia in 12cases(5.1%).The main grade 3-4 treatment-related adverse reactions in the neoadjuvant chemotherapy group were leucopenia in 12 cases(5.9%),abnormal liver function in 11 cases(5.8%)and anemia in 10 cases(5.3%).There was no significant difference in the incidence of toxic and side effects between the two groups.Cox univariate analysis showed that age,clinical stage,pathological T stage,pathological N stage and tumor location were correlated with overall survival.Gender,Lauren classification,degree of differentiation and R0 resection were not related to overall survival.Multivariate analysis showed that age,clinical stage,pathological N stage and tumor location were independent prognostic factors of gastric cancer.Conclusions:Perioperative chemotherapy did not prolong the 5-year survival of patients with gastric cancer,and neoadjuvant chemotherapy was as safe as adjuvant chemotherapy.Age,clinical stage,pathological N stage and tumor location are independent prognostic factors of gastric cancer,which should be paid great attention.