| Objective Through retrospective study,analysis of the application of transformation therapy in the treatment of stage ? gastric cancer,explore its safety and efficacy.Method According to the inclusion criteria and exclusion criteria,54 patients with ? gastric cancer from Department of Gastrointestinal Surgery,the First Affiliated Hospital of Fujian Medical University from January 1,2013 to December 31,2016 were selected.After surgical treatment,surgically resected stage ? gastric cancer was performed in 25 patients who underwent chemotherapy alone.1)Collect 54 statistical data(age,gender),chemotherapy regimen,evaluate chemotherapy efficacy and analyze chemotherapy side effects according to the National Cancer Institute-Common Criteria for Adverse Reaction Events(NCI-CTCAE Version 3.0).(2)Surgical treatment after transformation The thickness of tumor foci measured before and after chemotherapy was measured in 29 patients.CEA,CA125,and CA199 were calculated.Surgical methods,postoperative clinical pathology(tumor location,histopathology),and postoperative complications were evaluated according to Clavien-Dindo classification.The median number of surgical operations,median blood loss,and postoperative hospital stay were calculated.The median survival time(MST)of patients undergoing conversion therapy based on telephone follow-up,outpatient follow-up,and in-hospital review was calculated using the Kaplan-Meier method and the survival rate was assessed using an extensive Wilcoxon test.Result 1.Evaluation of chemotherapy efficacy: 54 patients received S-1 plus docetaxel in 3 cases,m DCF(docetaxel + cisplatin + fluorouracil)regimen in 14 cases,received FLOFOX6(Oxaliplatin + fluorouracil + leucovorin 29 cases of chemotherapy regimen received docetaxel + oxaliplatin + fluorouracil in 8 cases,after receiving 3-6 cycles of chemotherapy there were CR(complete remission)0 cases,PR(partial remission)32 cases,SD(stable)16 cases,PD(progression)in 6 cases.ORR(effectiveness)was 21(72.4%)in the conversion surgery group,DCR(control rate of disease)was 29(100%),ORR(effectiveness)in the chemotherapy alone group was 11(44%),and DCR(disease control)The rate was 19(76%).2.29 cases of post-transformation stage ? gastric cancer patients with pre-chemotherapy serum CEA increased 11 cases(39.2%),CA125 increased to 5 cases(17.9%),CA199 increased 13 cases(46.4%),chemotherapy-related tumors Most of the markers were degraded.Statistical analyses of tumor markers before and after chemotherapy were performed to analyze abnormal tumor markers.The decrease in CA125 was statistically significant(P<0.05).There was no significant difference in the decline of CEA and CA199 before and after chemotherapy.3.The main adverse reactions to chemotherapy were nausea,vomiting,loss of appetite,bone marrow suppression,adverse reactions,9 cases of nausea in grade 1,2 grade,1 case of nausea in grade 3,4 cases of vomiting in grades 1 and 2,and 1 case of grade 3 vomiting.Grade 1 and 2 loss of appetite in 15 cases,Grade 3 loss of appetite in 2 cases,Grade 1 and Grade 2 leukocytes in 10 cases,Grade 3 leukocytes in 1 case,Grades 1 and 2 platelets in 4 cases,Grade 3 leukocytes in 1 case,1 Grade 2 haemoglobin decreased in 17 cases,and 4 cases decreased in grade 3 hemoglobin.4.The median operative time for 4.29 surgical patients was 176 min(120-305),the median blood loss was 200 ml(100-500),and the average postoperative hospital stay was 13.2±3.0 days.Gross pathological analysis after surgery: R0 surgery in 20 cases,R1 surgery in 3 cases,no perioperative death.All surgical complications occurred in 6 patients(21.4%),4 Grade 2 pulmonary infections were observed after surgery,1 Grade 2 anastomotic bleeding and Grade 2 pulmonary infection,1 Grade 2 pulmonary infection and Grade 2 Intra-abdominal infection.5.The MST(median survival)of all 29 patients in this study was 24 months,the MST of 25 patients with chemotherapy alone was 8 months,and the 2-year cumulative survival rate between the two groups was 45.The difference of survival rate was statistically significant(X2=35.005,P<0.05).The patients receiving R0 resection and those receiving non-R0 resection were 24 months and 13 months,respectively.Conclusion 1.For patients with potentially resectable ? gastric cancer,the selection of a suitable conversion treatment regimen can increase R0 resection and prolong the survival of the mid-life.2.There was no significant increase in postoperative complications and postoperative hospital stay in patients with stage ? gastric cancer undergoing conversion therapy.survival for most patients.Patients with advanced gastric cancer are appropriately selected for conversion therapy to obtain a good prognosis. |
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