Comparison Of Clinical Efficacy Of DOS Regimen And SOX Regimen In Neoadjuvant Chemotherapy For Advanced Gastric Cancer

Objective: To compare the clinical efficacy of DOS regimen(docetaxel,oxaliplatin,S-1)and SOX regimen(oxaliplatin,S-1)in neoadjuvant chemotherapy for advanced gastric cancer,and to provide clinical guidance of optimizing the neoadjuvant chemotherapy regimens for advanced gastric cancer.Methods: Clinical data of 49 patients with advanced gastric cancer who were treated with neoadjuvant chemotherapy in the same group of gastrointestinal surgery department at the Affiliated Hospital of Northern Sichuan Medical College from May 2013 to October 2017 were continuously collected.The patients were divided into DOS group(24 cases)and SOX group(25 cases)according to the chemotherapy regimen.The DOS group underwent neoadjuvant chemotherapy with the DOS regimen,and the SOX group underwent neoadjuvant chemotherapy with the SOX regimen.After 3 cycles of neoadjuvant chemotherapy,imaging efficacy evaluation was performed.After neoadjuvant chemotherapy was completed,radical resection of gastric cancer was performed after 2 weeks of rest.Observe and compare the radiographic efficacy,tumor stage declination,radical surgical resection,incidence of postoperative complications,survival prognosis chemotherapy adverse reactions after neoadjuvant chemotherapy between the two groups.Results: All patients completed 3 cycles of neoadjuvant chemotherapy.Compared DOS group with the SOX group,the overall response rate(ORR,75% vs 35%,P<0.05)was statistically different between the two groups.However,in terms of disease control rate(DCR,95% vs 100%,P>0.05),radical resection rate(95.8% vs 88.0%,P>0.05)and postoperative complication rate(29.2% vs 40.0%,P>0.05),the difference was not statistically significant.In the DOS group,there were 6 cases of pathological stage I,10 cases of stage II,8 cases of stage III,and in SOX group,there were 1 case of stage I,4 cases of stage II,and 20 cases of stage III,it had significantly difference in each stage between the two groups(P<0.05).Both groups had experienced varying degrees of adverse reactions during neoadjuvant chemotherapy.Leukopenia,neutropenia,thrombocytopenia,nausea and vomiting were the mainly adverse reactions.The incidence of neutropenia and neutropenia in the DOS group was significantly higher than that in the SOX group(P<0.05),but it was safe and controllable.The median follow-up time was 6~39 months after surgery.The median overall survival(OS)in the DOS group was 33 months(95% CI: 24.8~41.2),and the median disease-free progression(DFS)was 33 months(95%CI: 24.7~41.2);median OS in the SOX group was 24 months,and median DFS was 19 months(95% CI: 11.8 ~ 26.2);both median OS and median DFS had significantly difference between the two groups,P<0.05.Conclusion: The DOS regimen has superior imaging results,neoplasm reduction,and long-term prognosis in neoadjuvant chemotherapy for advanced gastric cancer than SOX regimen.The incidence of adverse myelosuppression in neoadjuvant chemotherapy with DOS regimen is higher than that of SOX regimen,it is worth paying attention and strengthening monitoring and management.The DOS regimen is preferred for use in neoadjuvant chemotherapy for advanced gastric cancer.