The Effect Of Neoadjuvant Chemotherapy On The Efficacy And Safety Of Gastric Cancer Surgery

Objective: To explore the effect of neoadjuvant chemotherapy(NAC)on the efficacy and safety of gastric cancer surgery.Methods: Retrospective collection and analysis of clinical data and short-term follow-up data of patients undergoing radical gastric cancer resection from January 2016 to September 2020 in the First Affiliated Hospital of Xiamen University.According to whether neoadjuvant chemotherapy is taken,they are divided into 40 cases in neoadjuvant group and 243 cases in surgical treatment group.Then according to age,gender,BMI,surgical method,tumor stage,1:1 propensity score matching is performed.After matching,they are divided into 40 cases in neoadjuvant group and 40 cases in surgery group.The two sets of general message is equivalent and comparatively.Analyze the efficacy and pathological response rate of the neoadjuvant chemotherapy,compare and analyze the surgical R0 resection rate,the number of nodeslymph dissection,the number of lymph node-positive,the changes of CEA,CA199,CA724 tumor indicators before and after treatment,operation time,intraoperative bleeding,and postoperative hospital stay,shortterm postoperative complications,survival,and further subgroup analysis of the SOX program and XELOX program in the neoadjuvant group,divided into SOX group and XELOX group..Results: All operations are successfully completed without any deaths.(1)Efficacy:(1)Neoadjuvant group 57.5%;(2)SOX group 64%,XELOX group 46.6%,P>05.0,the discrepancy is not provided with statistically consequence;(2)Adverse reactions after chemotherapy: SOX group and XELOX group have liver function abnormalities and hand-foot syndrome,compared between the two groups,P<05.0,the discrepancy is provided with statistically consequence;(3)Surgical R0 resection rate:(1)Neoadjuvant group 92.5%,Surgery group 75%,P<05.0,the discrepancy is provided with statistically consequence;(2)SOX group 92%,XELOX group 93.3%,P>05.0,the discrepancy is not provided with statistically consequence;(4)Number of lymph nodes cleansing:(1)Neoadjuvant group(26.98±9.42),Surgery group(35.23±14.11),P<05.0,the discrepancy is provided with statistically consequence;(2)SOX group 24(20-32.5),XELOX group 27(20～33),P>05.0,the discrepancy is not provided with statistically consequence;(5)Number of positive lymph nodes:(1)Neoadjuvant group 2(0～4.75),Surgery group 5(1～16.50),P<05.0,the discrepancy is provided with statistically consequence;(2)SOX group 2(0～4),XELOX group 4(1～7),P<05.0,the discrepancy is provided with statistically consequence;(6)The changes of CEA,CA199,CA724 tumor indicators before and after treatment:(1)The discrepancy of CEA in the neoadjuvant treatment group is 1.41(0.38～7.21)ng/ml,and the discrepancy of CEA in the surgery group is 0.41(-0.09～0.99)ng/ml,P<05.0,the discrepancy is provided with statistically consequence;(2)The discrepancy of CEA in the SOX group is 1.36(0.22～6.09)ng/ml,and the discrepancy of CEA in the XELOX group is 2.15(0.36～18.90)ng/ml,P>05.0,the discrepancy is not provided with statistically consequence;(1)The discrepancy of CA199 in the neoadjuvant group is 10.57(1.43～28.14)u/ml,and the discrepancy of CA199 in the surgery group is 3.14(-2.03～5.84)u/ml,P<05.0,the discrepancy is provided with statistically consequence;(2)The discrepancy of CA199 in the SOX group is 7.90(0.40～28.59)u/ml,and the discrepancy of CA199 in the XELOX group is 15.97(4.85～28.61)ng/ml,P>05.0,the discrepancy is not provided with statistically consequence;(1)The discrepancy of CA724 in the neoadjuvant group is 1.85(0.38～15.70)u/ml,and the discrepancy of CA724 in the surgery group is 1.23(0.21～4.19)u/ml,P>05.0,the discrepancy is not provided with statistically consequence;(2)The discrepancy of CA724 in the SOX group is 3.61(0.47～20.01)u/ml,and the discrepancy of CA724 in the XELOX group is 1.12(-0.29～13.79)ng/ml,P>05.0,the discrepancy is not statistically significant;(7)Operation duration:(1)Neoadjuvant group(244.38±33.75)min,Surgery group(274.63±49.67)min,P<05.0,the discrepancy is provided with statistically consequence;(2)SOX group(243.40±35.99)min,XELOX group(246.00±30.78)min,P>05.0,the discrepancy is not provided with statistically consequence;(8)surgical operation bleeding:(1)Neoadjuvant group 100(50-200)ml,Surgery group 100(52.5～200)ml,P>05.0,the discrepancy is not provided with statistically consequence;(2)SOX group 100(50～225)ml,XELOX group 100(50～200)ml,P>05.0,the discrepancy is not provided with statistically consequence;(9)Postoperative hospital stay:(1)Neoadjuvant group 13(11～17)d,Surgery group 13(11～15)d,P>05.0,the discrepancy is not provided with statistically consequence;(2)SOX group 13(12～17)d,XELOX group 11(11～16)d,P>05.0,the discrepancy is not provided with statistically consequence;(10)Postoperative pathological response rate:(1)Neoadjuvant group 62.5%;(2)SOX group 68%,XELOX group 53.3%,P>05.0,the discrepancy is not provided with statistically consequence;(11)Short-term postoperative complications:(1)Neoadjuvant group 6 cases,Surgery group 4 cases,P>05.0,the discrepancy is not provided with statistically consequence;(2)group SOX 5 cases,group XELOX 1 case,P>05.0,the discrepancy is not provided with statistically consequence;(12)Postoperative recurrence:(1)Neoadjuvant group 5 cases,Surgery group 9 cases,P>05.0,the discrepancy is not provided with statistically consequence;(2)group SOX 3 cases,XELOX group 2 case,P>05.0,the discrepancy is not provided with statistically consequence;(13)Survival:the neoadjuvant group have a mortality rate of 17.5%,the surgery group have a mortality rate of 30%,compared the overall survival curve of the two groups,P>05.0,the discrepancy is not provided with statistically consequence;the 1-year survival rate is95.7% in the neoadjuvant group,and the surgery group is 77.5%,P<05.0,the discrepancy is provided with statistically consequence.Conclusion: Neoadjuvant chemotherapy can increase the R0 resection rate,reduce the number of lymph node dissections and positive lymph nodes,and shorten the operation time.In addition,neoadjuvant chemotherapy does not increase the incidence of shortterm postoperative complications,and can improve the 1-year survival rate after surgery.CEA,CA199 decreased significantly,and further subgroup analysis found that the SOX regimen had lower adverse reactions than the XELOX regimen.