Comparation Of The Clinical Effectiveness Of FOLFOX4 And FLP Regimen In Esophagogastric Junction Carcinoma And Distal Gastric Carcinoma

Objective: Gastric cancer is one of the most common cancer and the most leading cause of cancer death in our country.In recent years,since the incidence of Esophagogastric Junction carcinoma (EGJ carcinoma)is getting higher,the particularity of Esophagogastric Junction attracts more and more attention. In past years, lots of researchers confuse it with gastric cancer and esophageal carcinoma, however, a great number of literatures show its special position in dissection, so it is more different with esophageal carcinoma and gastric cancer in epidemiology, nosazontology, clinical pathology,therapy and prognosis. So it should be treated as a independent tumor not only in researching but also in clinic. According to the statistic of the nation-wide gastric carcinoma patients, 5-year-survival rate is 37%-50%, but in EGJ carcinoma it's just 20.2%-35.3%, which is worse than gastric cancer. Although nowadays the first and second prevention work raises the checking rate of early stage of gastric cancer, still more than half patients have the localized advanced or metastatic disease who can not have radical surgery.The adjuvant and first-line chemotherapy will extend the survial time and enhance the life quality, which has became a common view.But gastric cancer still has no standard adjuvant and first-line chemotherapy regimen now,and EGJ carcinoma follows the treatment method of gastric cancer for a long time,so there are not"Golden Standard"chemotherapy regimen for both of them. Cisplatin uniting with Fluorouracil was the common regimen in gastric cancer treatment,and some clinical trials ,REAL-2 for example, had confirmed that chemotherapy regimens containing Oxaliplatin were effective. So in recent years,FOLFOX4 regimen which contained oxaliplatin also gradually applied in the treatment of gastric cancer. This research will retrospectively analysis the effectiveness of FOLFOX4 and FLP regimen in EGJ carcinoma and distal gastric carcinoma's adjuvant chemotherapy and first-line chemotherapy, which will help the EGJ carcinoma and distal gastric carcinoma patients to choose the better chemotherapy scheme.Methods:1 Comparing the clinical effect of FOLFOX4 and FLP regimen in postoperative adjuvant chemotherapy of EGJ carcinoma and diatal gastric carcinoma.We Collected 553 patients'data with the "gastric carcinoma" and "EGJ carcinoma" in the medical oncology department of Fourth Hospital of Hebei Medical University from March 01 2007 to October 31 2009 to establish the database. There are 362 patiens receiving adjuvant chemotherapy after the radical surgery, from whom we choose 267 patients as the research object who receiving FOLFOX4 and FLP regimen, among them there are EGJ carcinoma 123 examples and distal gastric carcinoma 144 examples. The main observation targets are Disease-Free Survival(DFS), Overall Survival(OS), Hematology and Non-Hematology toxicities.And according to gender (male/female),age(≤45/46-65/>65),pathology type (adenocarcinoma/mucinous adenocarcinoma/signet ring cell carcinoma/others), stage (I/II/IIIA/IIIB/IV), lymph nodes cutting number (≤15/>15)to make delamination, to analysis two group's effect, in order to compare the effectiveness and toxicity of two regimens in EGJ carcinoma and distal gastric carcinoma. 2 Comparing the clinical effectiveness of FOLFOX4 and FLP regimen in EGJ carcinoma and distal gastic carcinoma in first-line chemotherapy. 299 patients acceptted first-line chemotherapy in our database, from whom we choose 164 examples receiving FOLFOX 4 and FLP regimen as the research object (newly diagnosed 114 examples,recurrented as who progressing after adjuvant chemotherapy 50 examples),containing 80 examples of esophagogastric junction carcinoma and 84 examples of distal gastric carcinoma. The main observation targets are Progression-Free Survival(PFS) and OS, and also divide into groups to count according to the whole case, newly diagnosed advanced case,recurrented case (progressing after the postoperative adjuvant chemotherapy).3 Information following-up will be from outpatient, reback to hospital, and telephone following-up.The termination of following-up is dead time and final following-up. The deadline of the following-up was on December 31, 2010.4 Statistics analysis uses SPSS13.0 software.Chi-square test was used for the balance test,survivial rate stratified analysis finished by stratified Chi-square test and DFS & PFS & OS calculated using Kaplan-Meier. All tests were performed at the 0.05 level of significances.Results:1 Comparation of the clinical effectiveness of FOLFOX4 and FLP in EGJ carcinoma and distal gastric carcinoma in adjuvant chemotherapy after radical surgery.1.1 Comparation of the clinical effectiveness of FOLFOX4 and FLP in EGJ carcinoma as postoperative adjuvant chemotherapy .The median DFS of FOLFOX4 and FLP regimen are 35.9 months and 16.8 months respectively(P=0.008), the median OS of FOLFOX4 and FLP regimen are 41.3 months and 25.6 months respectively(P=0.013);Stratified analysis shows that for the male patient, age of 46-65, with adenocarcinoma,staging II or IIIA, FOLFOX4 possesses of distinguished survival advantage (P<0.05),OR value respectively are 2.522(95%CI:1.100-5.780;P=0.041), 3.095(95%CI:1.177-8.137;P=0.018), 2.291(95%CI:1.017-5.158;P=0.048) ,6.667(95%CI:0.244-35.714;P=0.030),2.969(95%CI: 1.033-8.532;P=0.040). FOLFOX4 and FLP regimens are tolerable, and hematology toxicities does not show significant difference. FOLFOX4 regimen's non-hematology toxicities mainly shows peripheral neurotoxicity , and FLP regimen's is gastrointestinal reaction.1.2 Comparation of the clinical effectiveness of FOLFOX4 and FLP in distal gastric carcinoma as postoperative adjuvant chemotherapy. The median DFS of FOLFOX4 and FLP regimen are 35.8 months and 31.8 months respectively(P=0.925), the median OS of FOLFOX4 and FLP regimen are 46.6 months and 43.5 months respectively(P=0.720).Stratified analysis displays survival rate has no significant difference between the stratified factors(sex,age, Pathologic types, stage, Excision lymph node) in FOLFOX4 and FLP regimen.FOLFOX4 and FLP regimen's hematology toxicities does not show significant difference, both are tolerant.Non-hematology toxicities of two scheme respectively show in peripheral neurotoxicity and gastrointestinal reaction.2 Comparation of the clinical effectiveness of FOLFOX4 and FLP in advanced EGJ carcinoma and distal gastric carcinoma in first-line chemotherapy.2.1 Comparation of the clinical effectiveness of FOLFOX4 and FLP in advanced EGJ carcinoma as first-line chemotherapy .In all cases,the median PFS of FOLFOX4 and FLP regimen are 7.8 months and 6.4 months respectively(P=0.429), the median OS of FOLFOX4 and FLP regimen are 13.4 months and 13.7 months respectively(P=0.846);In newly diagnosed cases, the median PFS of FOLFOX4 and FLP regimen are 8.4 months and 6.0 months respectively(P=0.960), the median OS of FOLFOX4 and FLP regimen are 14.4 months and 13.7 months respectively(P=0.396);In recurrented cases, the median PFS of FOLFOX4 and FLP regimen are 5.6 months and 6.4 months respectively(P=0.184), the median OS of FOLFOX4 and FLP regimen are 10.6 months and 11.4 months respectively(P=0.471).2.2 Comparation of the clinical effectiveness of FOLFOX4 and FLP in advanced distal gastric carcinoma as first-line chemotherapy .In all cases,the median PFS of FOLFOX4 and FLP regimen are 7.6 months and 5.6 months respectively(P=0.556), the median OS of FOLFOX4 and FLP regimen are 14.9 months and 9.6 months respectively(P=0.421);In newly diagnosed cases, the median PFS of FOLFOX4 and FLP regimen are 7.6 months and 7.0 months respectively(P=0.406), the median OS of FOLFOX4 and FLP regimen are 17.6 months and 14.2 months respectively(P=0.415);In recurrented cases, the median PFS of FOLFOX4 and FLP regimen are 6.2 months and 3.3 months respectively(P=0.021), the median OS of FOLFOX4 and FLP regimen are 16.3 months and 6.9 months respectively(P=0.022). Conclusions:1 Retrospective research shows that within the EGJ carcinoma,comparing LFP regimen,the application of FOLFOX4 regimen in postoperative adjuvant chemotherapy can take a longer DFS and OS.Stratified analysis shows that for the male patient, age of 46-65, with adenocarcinoma,staging II or IIIA, FOLFOX4 can enhance the survival rate. 2 Within the adjuvant chemotherapy of distal gastric carcinoma,betweenFOLFOX4 and FLP regimen ,there were no statistically significant difference in DFS , OS and survival rate .3 Within the first-line chemotherapy of advanced EGJ carcinoma,between FOLFOX4 and FLP regimen ,there were no statistically significant difference in PFS and OS.4 Within the first-line chemotherapy of advanced distal gastric carcinoma, between FOLFOX4 and FLP regimen,there were no statistically significant difference in PFS and OS in all patients.In recurrented cases,FOLFOX4 regimen can extend the PFS and OS.