Evaluation Of Efficacy And Prognostic Factors Of Neoadjuvant Chemotherapy For Advanced Gastric Cancer

Objective:The clinical and pathological data of advanced gastric cancer treated with neoadjuvant chemotherapy were retrospectively collected.The relationship between clinical and pathological data and neoadjuvant chemotherapy efficacy and TRG was analyzed.The relationship between clinical pathology and efficacy and prognosis was also analyzed to guide the application of neoadjuvant chemotherapy.Methods: The clinical and pathological data of patients with advanced gastric cancer who underwent neoadjuvant chemotherapy and surgery were retrospectively collected from December 2012 to December 2017 in the Department of Gastrointestinal Surgery,Affiliated Tumor Hospital of Guangxi Medical University.A total of 80 patients.The prognostic value of RECIST criteria,tumor regression grade TRG,lymph node status,and tissue differentiation degree were explored by single factor and multivariate statistical analysis.RESULTS:Of the 80 patients enrolled,the age ranged from 28 to 73 years,with an average age of 55.05 ± 9.80 years,a median survival time of 42 months,and a five-year survival rate of 39%.34(42.5%)patients died during follow-up.32(40%)patients in stage 0-II after surgery,which reached pathological downgrade before surgery.There were 11 patients(13.8%)with TRG0,15(18.8%)with TRG1,29(36.2%)with TRG2,and 25(31.2%)with TRG3.Tumor regression grade TRG was associated with tumor size,tumor differentiation,lauren classification,RECIST criteria evaluation,ypT,ypN,and postoperative pathological stage(P<0.05).TRG and RECIST were divided into reactive group and non-reactive group.The prognostic analysis of TRG 0-1(responding group)and TRG 2-3(non-responding group)showed that P=0.002,with statistical significance,showing that the survival prognosis of TRG 0-1 was better than that of TRG 2-3.The prognostic analysis of response group and non-response group by RECIST criterion indicated that P=0.071,which had no statistical significance.With TRG as the gold standard,the preoperative RECIST criteria showed lower accuracy in assessing whether there was a response group(P=0.029,AUC=0.651,95% CI: 0.522-0.780).Univariate analysis showed that tumor size(p=0.018),Lauren classification(P=0.004),ypT(P=0.016),ypN(P<0.001),post-operative pathological stage(P=0.005),TRG(P=0.01)had statistical significance with prognosis.Multivariate analysis showed that ypT(P=0.033),ypN(P=0.002)and pathological stage(P=0.013)were independent prognostic factors.Conclusions: In patients with advanced gastric cancer who received surgery after neoadjuvant chemotherapy,ypT,ypN and postoperative pathological stage were independent prognostic factors.The survival prognosis of patients with grade 0-1 TRG(reactive group)was better than that of patients with grade 2-3TRG(non-reactive group),and postoperative TRG assessment was necessary.