| Background and aims:The incidence of gastric cancer accounts for the fourth highest incidence of various types of cancer in the worldwide,and it is a common malignant tumor that endangering human health.Previous studies have shown that the incidence of gastric cancer in China accounts for about half of the total number of gastric cancers in the world.Compared with Japan and South Korea,which are widely used in early gastric cancer screening and treatment,China has a large number of advanced gastric cancers,and the survival time of patients is significantly shortened.Early gastric cancer(EGC)is defined as a tumor of stem from gastric epithelial,and its degree of infiltration is limited to the mucosal layer and submucosa,with or without lymph node metastasis.The 5-year survival rate of early gastric cancer can reach more than95%.Early screening and treatment can effectively prolong the disease-free survival of patients and improve their quality of life.In the past,the treatment of gastric cancer in the early stage was mostly treated with surgical open surgery.In recent years,with the improvement of endoscopic diagnosis and treatment,endoscopic diagnosis and treatment of early gastric cancer has been developed.Endoscopic treatment is now being accepted as an effective surgical procedure.The existing research confirms that lymph node metastasis is an important evaluation factor for the prognosis of early gastric cancer.Considering that endoscopic treatment can not clean the lymph nodes,it is necessary to strictly control the indications in the preoperative evaluation.Patients who are not suitable for endoscopic treatment can still choose surgery.Compared with advanced gastric cancer,early gastric cancer has fewer chemotherapy-related risk factors,so less chemotherapy is used.At present,the benefits of chemotherapy for early gastric cancer are still unclear.This article will discuss the benefits of chemotherapy after early gastric cancer surgery in combination with clinical cases.Methods:Retrospective analysis of clinical data from patients who underwent endoscopic treatment or surgery and who were diagnosed with early gastric cancer at the First Affiliated Hospital of Nanchang University from August 1,2009 to December 31,2016.Clinical date including age.,gender,tumor maximum diameter,tumor site,tumor differentiation,depth of tumor invasion,lymph node invasion and vascular tumor thrombosis and other pathological features.Patients with early gastric cancer who underwent surgical treatment were divided into chemotherapy group and non-chemotherapy group.The correlation between postoperative chemotherapy and pathological features was analyzed by X~2 test.P<0.05 was considered statistically significant.The disease status was divided into death and survival.The overall survival(OS)was defined as the time from the time of surgery to any cause of death or the time of the last follow-up.The Kaplan-Meier method was used to calculate the cumulative survival rate and recurrence rate,and The survival test was performed by the Rank test,and the difference was statistically significant at P<0.05.Results:(1)835 patients with early gastric cancer were enrolled.There were 820 patients underwent surgical treatment and 137 patients with lymph node metastasis.The total lymph node metastasis rate in the surgical group was 16.71%(137/820).There were15 cases in the endoscopic treatment group which 4 cases in the group have positive margin.The patients receiving chemotherapy accounted for 10.18%(85/835)of the total patients,of which 84 were in the surgical group.Univariate analysis of chemotherapy selection and pathological features showed that women,patients with low degree of differentiation,lesions located in the gastric antrum,lymph node metastasis,lesion invasion of the submucosa,and vascular tumor thrombosis preferred postoperative chemotherapy(P<0.05);The age,lesion size,and pathological type of the lesion were not associated with postoperative chemotherapy(P>0.05).(2)All 835 patients were followed up for 22-103 months,and the death toll was 46(cumulative mortality was 5.51%).The endoscopic treatment group survived during the follow-up period.There were 30 cases of gastric cancer recurrence,29cases in the surgical group and 1 case in the endoscopic treatment group.Among patients with lesions confined to the lining of the mucosa without lymph node metastasis,patients with postoperative chemotherapy had lower survival rates than those without chemotherapy(P<0.05).In patients with lesions invading the mucosal lining,the cumulative recurrence rate of patients receiving postoperative chemotherapy was higher than that of patients without chemotherapy(P<0.05).There was no significant difference in cumulative survival rate and cumulative recurrence rate between patients with lesions confined to the submucosa,with or without lymph node metastasis and chemotherapy(P>0.05).Conclusion:Univariate analysis of chemotherapy selection and pathological features showed that women,patients with low degree of focal differentiation,lesions located in the gastric antrum,lymph node metastasis,lesion invasion of the submucosa,and vascular tumor thrombosis preferred postoperative chemotherapy(P<0.05).Recurrence of lesions in early gastric cancer and death of patients often occur 2-3years after surgery.In patients with negative lymph node metastasis in early gastric cancer,especially in patients with deep lesions confined to the mucosal lining and no evidence of lymph node metastasis,chemotherapy did not significantly change long-term mortality and recurrence rate.In the near future,toxic reactions may occur,and clinical benefit may be small. |
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