Clinical Analysis Of Advanced Gastric Cancer With Neoadjuvant Chemotherapy In 108 Cases

ObjectivesLocal advanced gastric cancer with low complete resection and high recurrence rate is associated with poor prognosis.The aim of this study is to analyse the clinical efficacy and security for local advanced gastric cancer with neoadjuvant chemotherapy.MethodsFrom January 2013 to December 2017,108 cases of advanced gastric carcinoma were searched in the medical record system of the First Affiliated Hospital of Zhejiang University Medical College.All patients received mean 3.6 cycles of neoadjuvant chemotherapy,surgical treatment indications were evaluated by imaging.Pretreatment stage,schedule and course,objective response rate,adverse reaction,complete resection rate,pathological histology reaction and postsurgical complications.ResultsThe objective response rate is 54.6%(59/108)and disease control rate is 89.8%(97/108)of all cases.Compared with SPA(paclitaxel/S-1),patients received SOX(oxalipatin/S-1)have a higher ORR(58.2%vs.50.0%,P>0.05).The ORR of 2 cycles,3 cycles and 4 cycles with SOX is 64.7%,54.2%and 70.6%respectively(P>0.05).The main adverse events during chemotherapy are leukopenia/neutropenia(43.5%,Grade?-?:7.4%),liver dysfunction(10.2%,Grade III-IV:2.8%),gastrointestinal reaction(59.3%,no Grade ?-?).Ninety-nine cases underwent surgical resection after neoadjuvant chemotherapy,the D2 lymph node dissection rate is 70.7%(70/99),R0 resection rate reaches up to 86.9%(86/99).There is on significant difference of R0 resection rate between SOX and SPA(86.8%vs.85.0%,P>0.05).The pathological reaction rate of all surgical patients is 39.4%(39/99),SOX and SPA is 41.8%,22.7%(P>0.05),2 cycles,3 cycles and 4 cycles with SOX is 35.3%,45.8%and 35.3%respectively(P>0.05).Three cases(3.0%)even are found pathological complete response.Postsurgical complications including intestinal obstruction(n=7),pleural effusion and Lung infection(n=4),anastomotic stricture(n=3),abdominal infection(n=3),anastomotic leak(n=2),pancreatic fistula(n=1),wound infection(n=1)and pulmonary embolism(n=1).ConclusionsNeoadjuvant chemotherapy in local advanced gastric cancer demonstrated a very high clinical and pathological response rate,significantly improve complete resection rate with acceptable toxicities and complications.