Analysis Of Efficacy And Prognostic Factors Of Adjuvant Chemoradiotherapy After Radical Gastrectomy In 142 Cases Of Gastric Cancer

Objective:China is a country with high incidence of gastric cancer,and there are more new cases and related deaths cases than other countries every year.Surgical radical resection is still the preferred treatment for gastric cancer.However,most of the patients were in the local advanced stage of the tumors when they visited to the clinic.The curative effect of surgical resection alone was poor and the local recurrence rate was high.As an effective local therapeutic method,radiotherapy can effectively reduce the local recurrence rate and improve the prognosis of patients.The aim of this study was to analyze the clinical data of 142 patients with gastric cancer receiving adjuvant chemoradiotherapy after radical gastrectomy in our hospital,The data of survival and failure modes were obtained to evaluate the efficacy and acute toxicity of adjuvant chemoradiotherapy,and prognostic factors were analyzed to provide reference for evaluation of patients’prognosis and reasonable treatment in clinical.Method:A retrospectively analysis was performed on the clinical of 142 patients with gastric cancer after radical gastrectomy,who underwent adjuvant chemoradiotherapy in our hospital from September 2008 to December 2017.Data regarding general information of patients,treatment,tumor characteristics,acute toxicity(CTCAEv 5.0),survival and failure modes were collected.The total survival rate(OS)and progression-free survival rate(DFS)were calculated by Kaplan-Meier method.Log-rank method was used for univariate prognostic analysis.Cox regression risk model was used for multivariate analysis of statistically significant factors.Results:By December 30,2017,4 patients were lost to follow-up,the follow-up rate of 97.2%.The 1-,3-and 5-year overall survival rates were 77.1%,56.4%and 46.1%respectively,and the 1-,3-and 5-year disease-free survival rates were 66.5%,52.3%and 45.9%respectively.The incidence of grade 3～4 serious adverse reactions was 29 cases(20.4%)during the period of adjuvant chemoradiotherapy,including 18 cases of grade 3-4 myelosuppression(12.7%)and 14 cases of grade 3 gastrointestinal reactions(9.9%).Among them,3 cases(2.1%)had both serious adverse reactions simultaneously.After symptomatic treatment,all patients improved and no patients died of serious side-effects.During the follow-up period,there are 6 cases(4.2%)of local-regional recurrence(gastric-remnant,anastomotic stoma,tumor bed,regional lymph nodes),23 cases(16.2%)of abdominal implantation metastasis,18 cases(9.9%)of hepatic metastasis,12 cases(6.3%)of bone metastasis,9 cases(5.6%)of lung metastasis,and 6 cases(2.1%)of multiple organ metastasis.Univariate prognostic analysis showed that age,surgical margin,surgical resection method,degree of tissue differentiation,Lauren classification,depth of tumor invasion(pT),lymph node stage(pN),lymph node metastasis rate(MLR),pTNM stage,perineural invasion and lymphovascular invasion were the predictors of survival(P=0.030、P=0.046、P=0.000、P=0.005、P=0.009、P=0.001、P=0.000、P=0.000、P=0.001、P=0.002、P=0.000);Multivariate prognostic analysis showed that age,surgical margin,Lauren classification,lymph node stage(pN),lymph node metastasis rate(MLR)and lymphovascular invasion were the predictors of survival(P=0.011、P=0.000、P=0.030、P=0.002、P=0.000).Conclusion:After radical gastrectomy,adjuvant chemoradiotherapy can improve the local regional control rate and survival rate.The patients can tolerate the relatively mild adverse reactions and complete all treatment.The age,surgical margin,Lauren classification,lymph node stage(pN),lymph node metastasis rate(MLR)and lymphovascular invasionare independent prognostic factors for the overall survival.