| Objective:This article aims to investigate the effect of perioperative chemotherapy with SOX and XELOX on postoperative recurrence metastasis and prognosis of patients with advanced gastric cancer,and to clarify the advantages and disadvantages of perioperative chemotherapy compared with simple postoperative adjuvant chemotherapy for patients with advanced gastric cancer during perioperative chemotherapy.And the choice of treatment options provide the basis.Methods: A multi-center,randomized,controlled phase III clinical trial(NCT01516944)randomized 749 patients with advanced gastric cancer.Subjects who met the entry criteria were randomly assigned to a randomized1:1:1 ratio A,B,C three groups,including group A(operation + SOX regimen chemotherapy)290 cases,group B(SOX regimen neoadjuvant chemotherapy+ surgery + SOX regimen adjuvant chemotherapy)223 cases,groups C(XELOX regimen neoadjuvant chemotherapy + surgery + XELOX regimen adjuvant chemotherapy 236 cases.By comparing the recurrence pattern,recurrence time,recurrence rate,disease-free survival time(DFS)and overall survival(OS)between the two groups,the pros and cons of perioperative chemotherapy compared with adjuvant chemotherapy alone were compared.By comparing the recurrence pattern,recurrence time,recurrence rate,and disease-free survival(DFS)and overall survival(OS)between the two groups,the two perioperative chemotherapy regimens SOX and XELOX are progressing.Postoperative recurrence,metastasis and prognosis of gastric cancer patients.Multivariate analysis was used to identify independent risk factors affecting recurrence and metastasis.Result:1.The median recurrence time for patients with local recurrence in group A,B,and C was 23.5 months,25.0 months,and 25.0 months,respectively,and the local recurrence rate was 1.0% after 2 years.The median time to recurrence in the three groups of patients with peritoneal metastasis was 13.0months,27.0 months,and 15.0 months respectively.The rate of peritoneal metastasis was 4.4%,2.0%,and 4.0% in postoperative 2 years,respectively.The peritoneal metastasis rate in group B was 54.5% lower than that in group A,and the peritoneal metastasis rate in group B was 50.0% lower than that in group C.The median recurrence time of the three groups of patients with distant metastasis was 14.0 months,21.5 months,31.0 months,respectively.The distant metastasis rate at 2 years after surgery was 9.3%,4.0%,1.0%,respectively.The rate of distant metastasis in group B was lower than that of group A by 57.0%.The rate of distant metastasis in group C was 75.0% lower than that of group B.2.The median OS of the three groups A,B and C were 25.0 months,29.5months and 26.5 months respectively.The 2-year overall survival rates were70.0%,86.7% and 80.6%,respectively.There was a statistically significant difference between group A and B(P=0.000).There was no significant difference between groups B and C(P=0.189).The median DFS of the three groups was 25.0 months,28.0 months,and 26.0 months.The disease-free survival rate was 66.6%,82.4%,and 80.0% after 2 years.There was a statistically significant difference between group A and B(P=0.000);there was no significant difference between group B and C(P=0.196).3.Univariate analysis showed that age,T staging,N staging,pathological staging was associated with postoperative recurrence of advanced gastric cancer were significantly correlated(P<0.05);Multivariate analysis showed that age,N stage,and pathological stage were independent influencing factors of peritoneal metastasis and distant metastasis after radical gastrectomy in advanced gastric cancer(P<0.05).Conclusion:1.The effect of perioperative chemotherapy to control postoperativeperitoneal metastasis and distant metastasis in patients with advanced gastric cancer is better than that of adjuvant chemotherapy alone,and the perioperative SOX regimen is better than the XELOX regimen in controlling peritoneal metastasis,and the perioperative XELOX regimen is better than SOX regimen in controlling distant metastasis.2.Perioperative chemotherapy is more effective than adjuvant chemotherapy in prolonging DFS and OS in patients with advanced gastric cancer.Perioperative SOX and XELOX have the same effect on survival.3.Younger age and later pathological staging are independent risk factors for peritoneal metastasis;advanced age and lymph node metastasis are independent risk factors for distant metastasis. |
PDF Full Text Request