| Background: Gastric cancer is the fifth most common tumor in the world,and also an important cause of cancer-related death.At present,surgical resection is the only treatment for local gastric cancer,but only 20% of patients show resectable disease in diagnosis.Even radical resection,because of the high recurrence rate of the disease,the prognosis is still poor.In this regard,in order to reduce the recurrence rate and improve the survival rate,various countries in the East and the West have developed multi-mode perioperative treatment methods.R0 resection combined with D2 lymphadenectomy is the only treatment for resectable GC.However,in western countries,due to the lack of specific screening,the mortality of locally advanced gastric cancer is still high,and it is not suitable for early therapeutic surgery.In addition,the prognosis of lymph node positive patients is still poor even after radical resection,and the 5-year survival rate is only 20-30%.In this context,as a part of multimodal treatment,perioperative adjuvant therapy has been developed in the past few decades.Its fundamental purpose is to reduce local and distant recurrence after radical gastrectomy and improve the overall survival rate of patients.Objective: In order to improve the clinical effect of neoadjuvant chemotherapy for advanced gastric cancer patients in China,and further guide the clinical treatment,the clinical case data and characteristics of neoadjuvant chemotherapy for advanced gastric cancer patients were collected and analyzed retrospectively,the clinical effect of neoadjuvant treatment for advanced gastric cancer patients was observed,and the tumor recession grade(TRG grade)and clinical pathological characteristics after neoadjuvant treatment were discussed To provide clinical reference for preoperative neoadjuvant therapy and prognosis of patients with advanced gastric cancer,so as to guide the rational application of clinical neoadjuvant.Methods: From January 2016 to October 2019,we collected the basic clinicopathological data of advanced gastric cancer patients treated by neoadjuvant chemotherapy combined with surgery in gastrointestinal surgery of Henan people's hospital.All patients received oxaliplatin based SOX chemotherapy regimens neoadjuvant chemotherapy.After radical resection of gastric cancer,according to the set evaluation criteria(NCCN standard,RECIST standard),the patients were evaluated for TRG classification and solid tumor treatment response.The safety and efficacy of clinical treatment were evaluated.Further,the influence of TRG classification was discussed through single factor and multi factor statistical analysis Analysis of clinicopathological characteristics and risk factors.Results: In this study,97 patients with advanced gastric cancer who completed neoadjuvant chemotherapy and radical gastrectomy were included,and all patients were cured and discharged.The average age was 54.13 ± 9.61 years.The overall incidence of adverse reactions of neoadjuvant chemotherapy is relatively low,mainly manifested as 1-2 grade leucopenia,thrombocytopenia grade oral mucositis,etc.There were 6 cases of trg0,22 cases of TRG1,37 cases of trg2 and 32 cases of trg3.There were significant differences in the levels of CEA(P = 0.042),CT stage(P = 0.003),lymph node metastasis(P = 0.001),NAC course(P = 0.01),tumor maximum diameter(P = 0.013),tumor differentiation(P = 0.019),Lauren classification(P = 0.009),YPT(P = 0.001)and postoperative pathological stage(P < 0.001).The results of multivariate statistical analysis showed that CT staging(P < 0.001),tumor maximum diameter(P = 0.002),and lymph node metastasis(P < 0.001)were independent factors affecting TRG classification.In terms of the overall effect of neoadjuvant chemotherapy,there were 6 CR patients,37 PR patients,46 SD patients and 8 PD patients.The total response rate of neoadjuvant chemotherapy was 44.33%,and the disease control rate was 91.75%.Conclusions: The clinical effect of neoadjuvant chemotherapy for advanced gastric cancer patients is accurate,with high safety and feasibility.It is necessary to evaluate the patients with advanced gastric cancer in clinical work after neoadjuvant chemotherapy;TRG classification and CEA level before neoadjuvant chemotherapy,CT stage,lymph node metastasis,NAC course,tumor maximum diameter,tumor differentiation degree,Lauren classification,YPT,postoperative pathology There was statistical significance between stages,CT stage,tumor maximum diameter and lymph node metastasis were independent factors influencing TRG classification. |
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