Perioperative Chemotherapy With SOX And XELOX Regimens For Patients With Advanced Gastric Cancer Clinical Study Of Chemotherapy Effect And Its Influencing Factors

Objectives: To investigate the effects of neoadjuvant chemotherapy and its influencing factors in advanced gastric cancer,and provide basis for the selection of neoadjuvant chemotherapy and chemotherapy regimens for advanced gastric cancer.Methods: A total of 749 cases of advanced gastric cancer(T2-4NxM0)from a prospective,Multi-centered,open and randomized controlled phase III clinical trial(NCT01516944)from January 2011 to May 2015 in a number of hospitals were enrolled.They were randomly divided into 290 cases in group A,223 cases in group B,and 236 cases in group C.Group A received direct surgical treatment and performed SOX regimen for 6-8 cycles.In group B,2-4cycles of SOX regimen were performed before surgery,and surgery was performed 3 weeks after the end of chemotherapy.The 4-6 cycles of SOX regimen were continued after surgery..In group C,2-4 cycles of XELOX regimen were performed before surgery,and surgery was performed 3 weeks after the end of chemotherapy.The 4-6 cycles of XELOX regimen were continued after surgery.The evaluation indicators are as follows:(1)Compare the efficacy and disease control rate after preoperative chemotherapy between groups B and C.(2)Compare the clinical down period after preoperative chemotherapy between groups B and C.(3)Compare the postoperative pathological response rates between groups B and C.(4)Compare the R0 resection rates among the three groups A,B,and C.(5)Compare the overall survival and disease-free survival of A and B groups and B and C groups.(6)To CR+PR as a valid,SD+PD is invalid,to explore the relationship between neoadjuvant chemotherapy and clinicopathological features of advanced gastric cancer.Result:1.The total effective rates in groups B and C were 49.8% and 47.9%,respectively,with no significant difference(P=0.685).The disease control rates were 90.5% and 88.1% respectively,with no significant difference(P=0.396).2.The down-rates of B and C groups were 55.6% and 50.4% respectively,with no significant difference(P=0.266).3.The pathological response rates in groups B and C were 55.2% and55.9% respectively,with no significant difference(P=0.867).4.The R0 resection rates of patients A,B,and C were 81.7%(237/290),88.7%(198/223),and 83.1%(196/236),respectively.There was a statistical difference between group A and group B(P=0.004);there was no statistical difference between group B and C(P=0.067).5.The median survival time of A,B,and C group was 24.6 months,37.2months and 26.7 months respectively.There was a significant difference between A and B group(P=0.002).There was no significant difference between group B and C(P=0.106).The median disease-free survival time of patients A,B and C were 23.7 months,34.7 months and 25.8 months respectively.There was a statistically significant difference between group A and B(P=0.000).There was no statistical difference between group B and C(P=0.064).6.Tumor size and differentiated degree are independent influencing factors influencing the efficacy of neoadjuvant chemotherapy.Conclusion:1.There was no significant difference in the evaluation of clinical price,clinical decline,pathological response rate,and prognosis in the neoadjuvant chemotherapy SOX and XELOX regimens.2.The neoadjuvant chemotherapy can significantly improve the R0 resection rate and improve the prognosis of patients with advanced gastric cancer.3.Tumor size and differentiated degree were independent influencefactors of neoadjuvant chemotherapy chemotherapy effect.