Clinical Study Of Neoadjuvant Chemotherapy In Advanced Gastric Cancer

Objectives The aim of the study is to discuss the clinical efficacy and prognostic factors of neoadjuvant chemotherapy in patients with advanced gastric cancerMethods The clinical date and pathology results of 245 patients with advanced gastric cancer who were admitted to the first affiliated hospital of Zhejiang university medical college from March 2008 to December 2015 analyzed retrospectively.The neoadjuvant chemotherapy regimen included FOLFOX and SOX.Radical gastrectomy was performed within 2 weeks after neoadjuvant chemotherapy.Then the clinical data of such as surgical procedures and pathological results.Follow-up was performed by telephone and Outpatient examination to collect the survival data.The data were statistically analyzed and the multivariate analysis was performed.Results Of the 245 patients,141 were treated with FOLFOX and 104 with SOX.All patients underwent gastrectomy combined with D2 lymph node dissection,including 114 cases of distal gastrectomy,85 cases of total gastrectomy,and 46 cases of gastric resection combined with other organs.There were 31 patients of stage I,51 of stage ?,128 of stage ? and 24 of stage IV according to the yp TNM staging.11 cases had a complete pathologic response.The R0 resection rate was 87.3%,the 5-year disease-free progression rate was 44.8% and the 5-year overall survival rate was 49% in all patients.There was no significant statistical difference in the R0 resection rate(85.1% vs.90.4%,P> 0.05)between the FOLFOX group and the SOX group.But the 5-year disease-free progression rate(35.9% vs.57.7%,P<0.05)and the 5-year overall survival rate(40.5% vs.64.5%,P<0.05)had statistical differences between the two groups.The R0 resection rate in patients of stage I was 100% follow with 96.1% of stage ? and was 89.9% of stage ?.There was significant statistical difference in the R0 resection rate between stage I+? and stage ?(97.6%vs.89.9%,P<0.05).There were statistical differences in overall survival between each group except the comparison of stage I and stage ?.Univariate analysis showed that the prognosis of gastric cancer was related to gender,tumor size,yp T,yp N,and yp M and was not significantly related to age,ECOG score,and tumor site.Further multivariate analysis revealed that tumor size ? 5 cm(HR 1.598,95% CI 1.093-2.338,P = 0.016),R1/2 resection(HR 2.490,95%CI 1.518-4.085,P<0.001),yp M1(HR 2.587,95% CI 1.569-4.265,P <0.001)and yp N(P <0.001)were independent risk factors.Conclusions Neoadjuvant chemotherapy is effective for patients with advanced gastric cancer.Compared with FOLFOX,the SOX regimen performs better in improving prognosis.yp TNM staging can effectively Predict the postoperative survival of patients with neoadjuvant chemotherapy.Tumor size,Radical operation,yp N and yp M are independent risk factors of gastric cancer.