Analysis Of Clinical Efficacy And Prognostic Factors Of Systemic Chemotherapy Combined With Radiotherapy For Advanced Gastric Cancer

Objective:To study the clinical efficacy and prognostic factors of systemic chemotherapy combined with radiotherapy for advanced gastric cancer.Methods:194 patients with advanced gastric cancer treated with radiotherapy and chemotherapy from October 2006 to August 2016 were selected as the subjects of this study.The patients were divided into chemotherapy alone group(control group,n=92)and combined chemoradiotherapy group(observation group,n=102).Both groups treated with 5-fluorouracil,capecitabine or S-1 plus platinum protocol,or docetaxel combined with platinum with/without 5-fluorouracil regimen.For combined chemoradiotherapy group,palliative radiotherapy was performed for primary and/or metastatic lesions on the basis of chemotherapy,in order to compare the clinical efficacy of the two groups,and analyze the clinical and pathological characteristics(gender,age,pathological type,primary tumor site,KPS score)and treatment(chemotherapy regimen,the number of chemotherapy cycles completed,plus radiotherapy or not,and radiotherapy intervention time,etc)impact on clinical prognosis.Results:1.The short-term efficacy of chemotherapy alone was 1 case of CR(1.1%),14 cases of PR(14.2%),49 cases of NC(53.3%)and of 28 cases of PD(30.4%).The short-term efficacy of combined chemoradiotherapy group was 3 cases of CR(2.9%),17 cases of PR(16.7%),54 cases of NC(52.9%),28 cases of PD(27.5%),there was no significant difference between the two groups in curative effects(P>0.05).2.Improvement of clinical symptoms in two groups:the remission rate of clinical symptoms in simple chemotherapy group was 75/102(73.5%),and 90.6%(115/127)in combined chemoradiotherapy group.There were significant differences between the two groups in the improvement of clinical symptoms(P<0.05).3.The median survival time was 6.7 months in the chemotherapy alone group and 10.6 months in the combined chemoradiotherapy group.For the chemotherapy alone group,6 months survival rate was 62%,1 year survival rate was 22.8%,2 year survival rate was 7.6%;for combined chemoradiotherapy group,6 months survival rate was 83.3%,1 year survival rate was 38.2%,2 year survival rate was 13.7%.The median survival time of the combined chemoradiotherapy group was significantly higher than that of the chemotherapy alone group,the difference was statistically significant(P<0.05).4.For combined chemoradiotherapy group,the median survival time was 12.6 months in patients with only distant lymph node metastases,and 11.1 months in patients with locally advanced gastric cancer,9.8 months in patients with organ metastasis.The median survival time in the three groups have significant difference(P<0.05).5.The median survival time was 11 months in patients who treated with sequential chemoradiotherapy,and 9.5 months in patients who treated with concurrent chemoradiotherapy,but the difference was not statistically significant(P<0.05).6.Prognostic factors analysis:Single factor analysis showed that the location of primary tumor,metastatic sites,KPS score before treatment,whether or not to add radiotherapy and the number of cycles of chemotherapy were statistically significant.Multivariate analysis showed that the KPS score before treatment,the number of patients who received radiotherapy and the number of chemotherapy cycles were independent prognostic factors.Conclusion:This study shows that chemotherapy combined with radiotherapy significantly increased the median survival time,6 months survival rate and 1 year,2 year survival rate of patients with advanced gastric cancer,and it can significantly relieve the clinical symptoms of the patients,improve the quality of life.To compared with the organ metastasis patients and locally advanced patients who treated with combined chemoradiotherapy,the median survival time in patients with only distant lymph node metastases was significantly improved.Patients treated with sequential chemoradiotherapy had better survival compared with patients treated with concurrent chemoradiotherapy,but the difference was not statistically significant.A variety of factors have an impact on the prognosis of patients.KPS score before treatment,the number of cycles of chemotherapy and whether or not to add the radiotherapy are independent prognostic factors.