Role Of FOLFOX7 Neoadjuvant Chemotherapy Protocol In The Combined Therapy Of Advanced Gastric Cancer

Objective To evaluate the therapeutic effect of such new combined therapy as neo-adjuvant chemotherapy-surgery-adjuvant chemotherapy with FOLFOX7 on advanced gastric cancer. Methods and materials Clinical definite patients with advanced gastric cancer were randomly divided into two groups: group A treated with conventionally therapeutic group, post-operative adjuvant chemotherapy (n=15), group B treated with neo-adjuvant chemotherapy-surgery-adjuvant chemotherapy(CSC), mainly FOLFOX7. Preoperative abdominal CT, Doppler ultrasound, endoscope endoscopic ultrasonography and tumor markers such as CA199 and CEA were collected. Postoperative pathological examinations were required. General information such as pathological site, size, infiltrating depth, infiltrating range was required and immunohistochemistry examination was carried out to determine and compare micro vessel density (MVD), proliferating cell nuclear antigen(PCNA) and apoptosis/proliferation index(AI/PI). Effects of Neo-adjuvant chemotherapy on stage of advanced gastric cancer were assessed and possible mechanisms were interpreted. Complications incidence, pathological remission rate and R0 resection rate were also contrasted. Result Ultrasound gastro-scope and abdominal CT shows that number of intumesced abdominal lymph node, size of tumor and infiltration depth significantly reduced in group B. Tumor markers such as CEA and CA199 significantly reduced, and these markers reduced after chemotherapy even in the preoperative period in group B. 1. MVD and PCNA of tumor interstitial and infiltration margin reduced significantly in group B. 2. MVD and PCNA in group B decreased significantly after neo-adjuvant chemotherapy. 3.Apoptosis cells round tumor increased significantly in group B. 4. Metastatic lymph node reduced and R0 resection rate increased significantly after FOLFOX7 neo-adjuvant chemotherapy. 5. No significant change was found in complications between the two groups. Conclusions Clinical stages of tumor were reduced, resection rate, pathological remission rate and R0 resection rate were elevated and prognosis was better after preoperative chemotherapy. 1. Micro vessel and cell proliferation are important index for assessing metastasis and prognosis. 2. New micro vessel is closely related with solid tumor genesis, growth and metastasis. Affluent new micro vessel will certainly accelerate proliferation of tumor so as to promote growth, infiltration and metastasis of solid tumor. 3. Neo-adjuvant chemotherapy reduces MVD and PCNA, and reduction of MVD and PCNA may result in reduction of recurrence rate of cancer. 4. Neo-adjuvant chemotherapy may reduce clinical stage, eliminate micro-metastiasis, prevent or postpone recurrence and metastasis, decrease resection range and elevate resection rate. Neo-adjuvant chemotherapy may also expand laparoscope application in gastric cancer surgery.