| Objective:To investigate the effect of neoadjuvant chemotherapy combined with surgical treatment on the short-and long-term prognosis of patients with locally advanced gastric cancer,and to analyze the factors affecting the treatment effect and prognosis of patients.Methods:We collected clinical and pathological data from 66 patients who received preoperative neoadjuvant chemotherapy as the neoadjuvant chemotherapy group and 222 patients who did not receive neoadjuvant chemotherapy as the control group who underwent surgical treatment for locally advanced gastric cancer between January 1,2015,and January 1,2020,at No.1,School of Medicine,wannan.In 66 patients who received neoadjuvant chemotherapy,the effect of clinicopathologic features and OS on outcomes was assessed using the RECIST.To evaluate the effect of neoadjuvant chemotherapy on the treatment of gastric cancer,we compared the general clinical characteristics,surgical status,pathologic characteristics,short-term prognosis,and long-term prognosis of the two groups.Univariate analysis of OS and multivariate analysis of OS were used to explore the effect of neoadjuvant chemotherapy on the treatment and long-term prognosis of locally advanced gastric cancer.Results:1.The objective response rate(ORR)according to RECIST 1.1 was 29 cases(43.9%)and the disease control rate(DCR)was 59 cases(89.4%).2.By univariate analysis of clinicopathologic features and OS in patients receiving neoadjuvant chemotherapy,OS was statistically significant with respect to yp T stage(P=0.028)and yp N stage(P =0.040).Multivariate analysis of clinicopathologic features and OS in patients receiving neoadjuvant chemotherapy showed that yp T stage(P = 0.045)was an independent predictor of outcome in patients receiving neoadjuvant chemotherapy.3.Comparison of the general clinical characteristics of the two groups showed a statistically higher prevalence of anaemia(65.2% vs 43.9%)and hypoalbuminemia(74.2% vs 53.4%)among patients receiving neoadjuvant chemotherapy compared with those receiving placebo(P<0.05).4.In surgical aspects,both groups received D2 radical surgery,and there was no statistical difference between the two groups in surgical duration,intra-operative blood loss,combined organ resection,surgical technique,etc.(P>0.05).The number of intra-operative blood transfusions in neoadjuvant chemotherapy group(16.7%)was higher than in control group(8.1%),and the difference was statistically significant(P<0.05).5.On postoperative pathology,there was no significant difference in tumor location between the two groups(P>0.05).The differences in tumor diameter(P=0.05),total lymph node count(P=0.039),positive lymph node count(P=0.003),vascular tumor thrombus(P=0.009),and neurologic invasion(P<0.001)were statistically significant(P<0.05).6.Postoperative hospital stay was statistically significantly shorter in both groups(P =0.019)and shorter in both groups(P < 0.05).In terms of long-term outcome after surgery,the recurrence and metastasis rates were similar between the two groups,and the difference between the two groups had no statistical significance(P>0.05).Intraperitoneal lymph nodes(17.5 vs 2.9%)were statistically significant(P<0.05)at sites of systemic recurrence.Univariate analysis of OS and clinicopathologic characteristics across the entire population by propensity score matching showed that the patient group(P=0.027)and c N stage(P=0.007)were statistically significant(P<0.05).Multivariate analysis of OS and clinicopathologic characteristics in the general population showed that patient group(P=0.019)and c N stage(P=0.012)were independent predictors of outcome in patients with locally advanced gastric cancer.Conclision:1.Neoadjuvant chemotherapy does not improve the incidence of postoperative complications in patients with locally advanced gastric cancer.2.Yp T staging was an independent predictor of outcome in patients receiving neoadjuvant chemotherapy.3.In terms of survival time,preoperative neoadjuvant chemotherapy plus postoperative chemotherapy is preferable to postoperative chemotherapy followed by direct surgery. |
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