The Value And Prognosis Of Surgery Combined With Chemoradiotherapy In The Treatment Of Locally Advanced Gastric Adenocarcinoma

Objective:To explore the value of operation combined with radiotherapy and chemotherapy in the treatment of locally advanced gastric adenocarcinoma and its effect on prognosis.Methods:Based on the information given by the U.S.national cancer institute,Surveillance,Epidemiology and End Results（SEER）,this research selected 307 ethnic Chinese patients who underwent the radical surgical resection between 2010 and 2015.All patients were divided into two groups:group S（patients underwent surgery alone）and group S+C （patients underwent surgery and chemotherapy）.The S+C group was divided into two subgroups according to whether or not radiotherapy was performed:S+C₀ group（patients underwent surgery combined with chemotherapy alone）and S+C_Rgroup（patients underwent surgery combined with chemoradiotherapy）.Results:1.Among all patients,the median survival time（MST）of the S+C group and the S group was 70 and 31 months,respectively.The S+C group’s overall survival rate（OS）was significant higher than the S group（61%vs 44%,P<0.001）,which showed significant difference.Among all the patients receiving surgery and chemotherapy,the 3-year OS of the S+C_Rgroup was lower than that of the S+C₀ group（61%vs 63%,P=0.885）,meaning no statistically significant difference.2.In the group of gastric adenocarcinoma male patients among all patients,,the S+C group’s 3-year OS was significantly higher than the S group（68%vs 43%,P<0.001）.The result showed statistic difference.In the group of gastric adenocarcinoma female patients among all patients,the MST of the S+C group was 47 months,and the value of S group was 34months.The S+C group’s 3-year OS was slightly higher than the S group（53%vs46%,P=0.361）.The result showed no difference in statistic.3.In the group of patients more than 75-year-old,the MST of the S+C group was 70,and the value of S group was 37months.The S+C group’s 3-year OS was slightly higher than the S group（66%vs 55%,P=0.006）.The result shows no statistic difference.In contrast,in the group of patients less than 75-yrear-old,the MST of the S+C group was 27months,and the value of S group was 31months.The S+C group’s 3-year OS was significantly higher than the S group（28%vs 40%,P=0.881）.The result indicates statistic difference.4.Among all the patients,the MST of married patients in S+C group and S group was28 months and 24 months respectively,and the 3-year OS of S+C group was lower than that of S group（38%vs 39%,P=0.369）,The result shows no statistic difference.The MST of unmarried patients in The S+C group and the S group was 46 months and 24 months respectively,and the 3-year OS of the S+C group was higher than that of the S group（62%vs 36%,P=0.004）,The result indicates statistic difference.5.In the group of patients with non signet ring cell carcinoma,the MST of the S+C group was 70 months,and the value of S group was 31months.The S+C group’s 3-year OS was significantly higher than the S group（62%vs 48%,P=0.010）.The result shows statistic difference.In contrast,in the group of signet ring cell carcinoma patients,the MST of the S+C group was 47 months,and the value of S group was 34months.The S+C group’s 3-year OS was slightly higher than the S group（55%vs 34%,P=0.346）.The result indicates statistic difference.6.Among all the patients,patients withⅡperiod S+C group and S group of patients with MST 34,18 months,respectively,S+OS above 3 years of group C S group（62%vs29%,P=0.045）,The result shows statistic difference.Ⅲstage cancer,S+C group and S group of patients with MST 27,37 months,respectively,S+OS above 3 years of group C S group（78%vs 61%,P=0.314）,The result shows no difference in statistic.7.Among all the patients,the MST of patients in the S+C group and the S group with high degree of differentiation was 28 months and 24 months respectively,and the 3-year OS of the S+C group was lower than that of the S group（28%vs 34%,P=0.386）,The result shows no statistic difference.For patients with low degree of undifferentiation,the MST of patients in The S+C group and the S group was 33 months and 24 months respectively,and the 3-year OS of the S+C group was higher than that of the S group（84%vs 66%,P=0.045）,The result shows statistic difference.8.Among all patients,the MST of patients with tumor diameter≤5cm in group S+C and group S was 34 months and 18 months respectively,and the 3-year OS of group S+C was higher than that of group S（45%vs 32%,P=0.021）,with statistically significant difference.For patients with tumor diameter of>5cm,the MST was 31 months in the S+C group and 38 months in the S+C group,and the 3-year OS in the S+C group was lower than that in the S group（38%vs 44%,P=0.511）,but the difference was not statistically significant.9.Among all the patients,the MST of patients in the S+C group and the S group with the number of lymph nodes detected<30 were 32 and 24 months respectively,and the 3-year OS of the S+C group was higher than that of the S group（43%vs 39%,P=0.097）,The result shows no statistic difference.The number of lymph nodes detected≥30 patients,the MST of patients in group S+C and group S was 30 months and 27 months respectively,and the 3-year OS of group S+C was lower than that of group S（40%vs 45%,P=0.124）,The result shows no statistic difference.10.The results of multivariate analysis indicated that age was an independent risk factor for the prognosis of locally advanced gastric.Conclusion:1.In the ethnic Chinese population,applying surgery and chemotherapy to patients with locally advanced gastric adenocarcinoma is able to improve the median survival time and 3-year OS.However,combining the surgery and radiotherapy is unable to improve the median survival time and 3-year OS.For prognosis of patients with locally advanced gastric adenocarcinoma,age is an independent risk factor.2.1 For male patients with locally advanced gastric adenocarcinoma,the survival prognosis of the surgery combined with chemotherapy group was better than that of the surgery group alone.2.2 For patients with locally advanced gastric adenocarcinoma aged<75 years,the survival prognosis of the operation combined with chemotherapy group was better than that of the operation group alone.2.3 For patients with locally advanced gastric adenocarcinoma who are divorced or single,the survival prognosis of the surgery combined with chemotherapy group is better than that of the surgery group alone.2.4 For patients with locally advanced gastric adenocarcinoma whose pathological type was non-signet-ring cell carcinoma,the survival prognosis of the surgery combined with chemotherapy group was better than that of the surgery group alone.2.5 for seventh edition AJCC staging forⅡperiod patients with locally advanced gastric cancer,surgery combined chemotherapy group are better than on the prognosis of survival of the surgical group.2.6 For patients with locally advanced gastric adenocarcinoma diagnosed by pathology as low undifferentiated adenocarcinoma,the survival prognosis of the operation combined with chemotherapy group was better than that of the operation group alone.2.7 For patients with locally advanced gastric adenocarcinoma with tumor diameter≤5cm,the survival prognosis of the operation combined with chemotherapy group was better than that of the operation group alone.