The Analysis Of Efficacy And Safety Of MFOLFOX Regimen As Adjuvant Chemotherapy In Stage Ⅲ Gastric Cancer Patients After D2 Gastrectomy

Objective:To evaluate the efficafy and safety for oxaliplatin combined with 5-FU(mFOLFOX)regimen as postoperative adjuvant treatment in stage Ⅲ gastric cancer,as well as to determine the optimal chemotherapy cycle,and to predict prognostic factors affecting the survival of patients with stage Ⅲ gastric cancer.Methods:All patients were included in the first affiliated hospital of Nanchang University and underwent radical resection of D2 gastrectomy.The postoperative stage was stage Ⅲ.All patients were treated with mFOLFOX regimen(oxaliplatin 130mg/m~2on the first day,and 5-fluorouracil 2600mg/m~2+Leucovorin 200mg/m~2,repeated every 3weeks)as an adjuvant treatment.The Kaplan-Meier method was used to analyze the survival rate and the single factor analysis of the overall survival time was performed.The single factor with statistical significance was analyzed by multifactor analysis using the COX proportional hazards model.Results:From December 2010 to December 2014,there were 207 patients undergoing postoperative adjuvant chemotherapy for gastric cancer that met the above criteria,and 21 patients were lost to follow-up,and 186 patients were included in the statistics.The median number of chemotherapy cycles for all patients was 6 cycles(1-8 cycles),of which 82(44.1%)patients received mFOLFOX regimen for 2-5 cycles of chemotherapy and 104(55.9%)patients received 6-8 cycles of chemotherapy for this regimen.Until December 30,2017,a total of 126 patients had relapsed and 103patients died.The median RFS was 25 months(95%CI:17.1-32.9),and as well as the median OS was 40 months(95%CI:23.3-56.7).The median RFS in the≥6cycles chemotherapy group was 34 months(95%CI:22.4-45.6 months),and the median RFS in the<6 cycles chemotherapy group was 15 months(95%CI:2.6-27.4months),(P=0.028<0.05);The median OS for chemotherapy≥6 cycles hemotherapy group was 63 months(95%CI:42.6-83.4 months),and the median OS for<6 cycles hemotherapy group was 26 months(95%CI:12.7-39.3 months),P=0.008<0.05.The main grade 3-4 adverse reactions were leucocytopenia(11.8%),nausea(5.4%),vomitting(2.7%),peripheral neurotoxicity(1.6%).Conclusion:The mFOLFOX regimen can be a feasible and safe adjuvant treatment for stage Ⅲ gastric cancer undergoing D2 surgery.Compared with patients with less than 6cycles of postoperative chemotherapy,patients who achieved more than 6 cycles benefited significantly.Lmph node staging of gastric cancer is an important prognostic factor affecting survival.