| ObjectiveThe purpose of this study was to observe the effect of neoadjuvant chemotherapy on the recent outcome and long-term prognosis of gastric cancer patients and analyze the factors that affect the treatment effect and long-term prognosis of patients.MethodsThis study retrospectively collected 1460 patients with locally advanced gastric cancer who were treated at Qilu Hospital of Shandong University from January 1,2014 to January 1,2017,of which 96 patients received neoadjuvant chemotherapy before surgery.1364 patients who did not receive neoadjuvant chemotherapy during the same period were used as' a c.ontrol group.We evaluated the therap.eutic effect of neoadjuvant chemotherapy on patients with gastric cancer by comparing the clinical and pathological characteristics,surgical conditions,recent clinical outcomes,and long-term prognosis of the two groups of patients.At the same time,we conducted RECIST and TRG assessments on these 96 patients with neoadjuvant chemotherapy.Based on the TRG evaluation results,we divided the patients into a responding group(TRG 0-2 grade)and a non-responding group(TRG grade 3).We compared the clinical and pathological characteristics of the two groups of patients,and through OS univariate analysis and multivariate analysis to explore the factors that affect the effect of neoadjuvant chemotherapy and long-term prognosis.ResultsComparison between neoadjuvant chemotherapy group and control group:the anemia(28.1%vs.12.5%)and malnutrition(32.3%vs.15.0%)of preoperative complications in the neoadjuvant chemotherapy group were higher than the control group,and the difference was statistically significant(P<0.05).The clinical T stage and clinical N stage of the neoadjuvant chemotherapy group were later than those of the control group,and the difference was statistically significant(P<0.05).In the comparison of radical operation,the patients in neoadjuvant chemotherapy group were slightly lower than the control group(85.4%vs.89.1%),but the difference between the two groups was not statistically significant(P>0.05).The neoadjuvant chemotherapy group was lower than the control group in tumor diameter(5.07±2.28 vs.6.35±2.62),positive number of lymph nodes(6.99±3.32 vs.8.30±5.34),and vascular tumor thrombus(10.4%vs.18.5%),the difference was statistically significant(P<0.05).There was no significant difference between the neoadjuvant chemotherapy group and the control group in the overall incidence of postoperative complications(28.1%vs.19.9%).overall postoperative recurrence rate(32.8%vs.27.0%),and 3-year overall survival rate(P>0.05).RECIST and TRG evaluation results showed that the overall objective response rate of neoadjuvant chemotherapy patients was 44.79%,the disease control rate was 90.63%,and the pathological response rate was 55.21%.Based on this result.we divided the patients into 53 people in the response group and 43 people in the non-response group.We compared the clinicopathological characteristics of the two groups of patients.The results showed that there are statistical differences in tumor diameter(P=0.046),ypTNM stage(Pb=0.001).Borrmann classification(P=0.018).RECIST evaluation results of patients between the response group and the non-response group(P=0.015).The overall survival rate of patients in the response group(TRG 0-2 grade)was higher than that in the non-response group(TRG grade 3),the difference was statistically significant(P<0.05).The results of univariate analysis of OS and clinicopathological characteristics of neoadjuvant chemotherapy patients showed OS and tumor size(P<0.001).surgical resection range(P=0.008),ypT(P=0.010),ypN(P=0.001),TRG score(P=0.008),Borrmann classification(P=0.001)have statistical significance.The results of multivariate analysis of OS and clinicopathological characteristics of patients showed that tumor size(P<0.001),ypT(P=0.024),and ypN(P=0.006)were the independent factors affecting the prognosis of neoadjuvant chemotherapy patients.Conclusions1.Neoadjuvant chemotherapy does not increase the incidence of postoperative complications in patients with gastric cancer and can improve the long-term prognosis of patients.2.The survival prognosis of patients in the response group(TRG 0-2)is better than that in the non-response group(TRG 3).It is necessary to evaluate TRG after neoadjuvant chemotherapy for gastric cancer.3.Tumor size,ypT,ypN are independent factors that affect the prognosis of patients with neoadjuvant chemotherapy for gastric cancer. |
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