Evaluation Of The Difference Between FLOT And FOLFOX Regimens On Postoperative Chemotherapy For Advanced Gastric Cancer

Objective:To investigate the postoperative chemotherapy efficacy of FLOT and FOLFOX for advanced gastric cancer.Methods:A retrospective cohort study was used.Clinicopathological data of 311postoperative patients with advanced gastric cancer undergoing chemotherapy were collected in Lanzhou University Second Hospital from January 2013 to December 2018:including gender,age,CA199,CA125,CEA,AFP,chemotherapy,Borrmann classification,Lauren classification,degree of differentiation,tumor location,tumor size,T stage,N stage,surgical method;224 males and 87females;the median age was 58 years,and the age range was 26~82 years old.Of the 311patients,107 patients received FLOT(Docetaxel,Oxaliplatin,Calcium Folic Acid,and 5-Fu)chemotherapy and were assigned to the FLOT group;204 patients received FOLFOX4(Oxaliplatin,Calcium Folic Acid,and 5-Fu)chemotherapy,set to FOLFOX group.Follow-up was performed using a combination of outpatient,inpatient review,and telephone to understand the patient's chemotherapy status,postoperative survival,tumor recurrence,and metastasis.The follow-up period was February 2019.The measurement data of the normal distribution are expressed by Mean±SD,and the t test is used for comparison between groups.Count data were expressed as absolute numbers or percentages,and comparisons between groups were performed using?~2 tests or Fisher's exact probability method.Rank data are tested by rank sum.After adjusting the baseline data through propensity score matching(PSM),Kaplan-Meier method was used to draw the survival curve before and after PSM and calculate the survival rate(using the life table method to calculate the survival rate).Log-rank test was used to analyze the survival situation.A COX proportional hazard regression model was established for single and multiple factor analysis,and an interaction test was used for subgroup analysis.P<0.05 was considered statistically significant.Results:1.Cumulative survival analysis of patients in the two groups:Before PSM,the 1,3,and5 year cumulative survival rates of the FLOT group were 84.6%,44.6%,and 39.7%,and the 1,3,and 5 year cumulative survival rates of the FOLFOX group were 67.8%,33.2%and 27.8%;after PSM,the 1,3,and 5 year cumulative survival rates in the FLOT group were 83.2%,42.8%,38.2%,and the 1,3,and 5 year cumulative survival rates in the FOLFOX group were 72.2%,31.5%,27.7%.2.Analysis of the total survival time of the two groups of patients:before PSM,the median OS of the FLOT group and the FOLFOX group were 34 months and 21 months,respectively,with a significant difference(Log-rank P<0.05);after PSM,the FLOT group and the FOLFOX group The median OS were 34 months and 22 months,respectively,and the difference was statistically significant(Log-rank P<0.05).3.Analysis of the risk factors affecting patient survival:Before PSM,univariate analysis suggested that chemotherapy regimen,Borrmann classification,Lauren classification,degree of differentiation,tumor size,CA199,CA125,CEA,T stage,N stage and surgical method Relevant factors affecting patient survival(P<0.05).Multivariate analysis suggested that chemotherapy,Lauren classification,diffuse type,mixed type,CA199,N2 stage,and N3 stage were independent factors that affected patients'postoperative survival(HR 0.627,2.378,1.894,1.696,1.986,1.848,3.848;95%CI 0.445-0.884,1.662-3.401,1.280-2.804,1.193-2.410,1.186-3.039,2.609-5.676;P<0.05);after PSM,single factor analysis suggested Chemotherapy regimen,Lauren classification,degree of differentiation,tumor size,CA199,CEA,T stage,N stage,and surgical method were related factors that affected patients'postoperative survival(P<0.05).Multivariate analysis suggested that chemotherapy regimen,CEA,N2 Staging and N3 staging were independent factors that affected patients'postoperative survival(HR 0.622,1.732,2.217,4.039;95%CI 0.418-0.926,1.124-2.670,1.200-4.097,2.448-6.662;P<0.05).4.Subgroup analysis of the efficacy of two groups of chemotherapy:The exploratory subgroup analysis suggests that the difference between the efficacy of the FLOT group and the FOLFOX group in subgroups such as gender,age,Lauren classification,degree of differentiation,tumor location,tumor size,tumor marker,T stage,N stage,and surgical method is consistent(interaction P>0.05).5.Adverse reactions:The incidence of grade 3-4 leukopenia and nausea in the FLOT group during chemotherapy was 34.3%and 24.2%.The above indexes of the FOLFOX group were11.1%and 12.1%,respectively.By comparison,the differences were statistically significant(?2=15.213,4.889,P<0.05),and there was no statistically significant difference in the incidence of grade 3-4 anemia,thrombocytopenia,vomiting,and impaired liver and kidney function in the two groups.(P>0.05).Conclusion:1.The FLOT protocol can significantly improve the cumulative survival rate and prolong the overall survival time of patients with advanced gastric cancer after surgery;2.Chemotherapy scheme,Lauren classification,differentiation degree,tumor size,CA199,CEA,T stage,N stage,and surgical method are related factors that affect patients'postoperative survival,while chemotherapy scheme,CEA,N2 stage,and N3 stage are factors Independent influencing factors for patient survival;3.FLOT regimen can significantly increase the incidence of grade 3-4 leukopenia and nausea.