Affection Of Neoadjuvant Chemotherapy On Cell Apoptosis In Patients With Gastric Carcinoma

Background: Gastric cancer is one of the commonest malignant tumor in China,its mortality accounts for 23.93 percent in all malignant tumor,and the incidence of gastric cancer increases in the recent years. The treatment of gastric cancer is a combined therapy .Surgery is the primary modality for managing early-stage disease, but most patients who undergo a curative resection develop locoregional or distant recurrence. Surgery is the primary modality for managing early-stage disease, its 5 year's survival rate is 90 percent,but most patients who undergo a curative resection develop locoregional or distant recurrence.Recurrence and metastasis is the main reason of treatment failure.The chemotherapy effects after gastric cancer surgery is not as good as expected allthe time.So searching a more sensitive treatment plan is fundamental to direct clinical medication.This topic aimed to measure the changes of necrosis rates, architectureand apoptotic rate of patients'gastric cancer cells before and after neoadjuvant chemotherapy to judge whether each patient is sensitive to neoadjuvant chemotherapy,then toinstruct the selection and adjustment of neoadjuvant chemotherapy after surgery and to offer a new thought and method to combined therapy of gastric cancer.Objectives: to investigate the value of the determination of changes of apoptotic index levels of gastric cancer cells before and after neoadjuvant chemotherapy in judging the each patient's sensitivity to neoadjuvant chemotherapy;to evaluate whether the sensitivity of different differentiated gastric cancer patients to adjuvant chemotherapy is distinct and then to instruct the selection of postoperative adjuvant chemotherapy; to study whether apoptotic index levels of each patient before neoadjuvant chemotherapy to influence the patients'sensitivity to neoadjuvant chemotherapy and to predict the prognosis of tumor.Methods: Forty patients with gastric cancer is divided to three groups,including poorly differentiated(containing undifferentiation group) group, moderately differentiated group and well-differentiated group.The apoptosis and necrosis of the cancer cells before and after neoadjuvant chemotherapy is observed. Changes of apoptotic and necrosis rates of gastric cancer cells of the same patient before and after neoadjuvant chemotherapy were measured by flow cytometry.Results Apoptotic index levels of gastric cancer cells of patients in poorly differentiated(containing undifferentiated group)group,moderately differentiated group and well-differentiated group before neoadjuvant chemotherapy were 5.24±3.10%,12.5±3.08%,16.6±2.17%, respectively,whereas apoptotic index levels of gastric cancer cells of patients after neoadjuvant chemotherapy were 31.3±3.27%,28.9±2.54%,26.5±2.09%, respectively.Significant differences in AI are found in patients of each group before and after neoadjuvant chemotherapy(P <0.01); Significant differences in AI are found in patients of each group(P <0.05)between different groups; Apoptotic index levels of gastric cancer cells of all patients before neoadjuvant chemotherapy is 11.2±3.27%,while after neoadjuvant chemotherapy is 28.6±3.95%, Significant differences in AI are found all patients before and after neoadjuvant chemotherapy(P <0.01). Apoptotic index levels of each patient before neoadjuvant chemotherapy is inverse correlation to the changes of AI before and after neoadjuvant chemotherapy(r=-0.642,P <0.05)2) necrosis rates of gastric cancer cells of patients in poorly differentiated(containing undifferentiated group)group,moderately differentiated group and well-differentiated group before neoadjuvant chemotherapy were 4.32±0.32%,4.13±0.38%,3.85±0.3%,whereas necrosis rates of gastric cancer cells of patients after neoadjuvant chemotherapy were 5.29±0.53%,4.9±0.49%,4.22±0.54 %,Significant differences in necrosis rates are found in patients of poorly differentiated(containing undifferentiated group)group and moderately differentiated group (P <0.05), NO significant differences in necrosis rates are found in patients of well-differentiated group before and after neoadjuvant chemotherapy(P >0.05), Significant differences in necrosis rates are found in patients of each group before and after neoadjuvant chemotherapy(P <0.05); NO significant differences in the changes of necrosis rates before and after neoadjuvant chemotherapy are found in each group(P >0.05).Conclusion: Tumor cells is very sensitive to neoadjuvant chemotherapy,the apoptosis is a index to test the therapeutic effect of chemotherapeutics ;The AI of tumour cells before neoadjuvant chemotherapy can evaluate the sensitivity of patient to chemotherapy;The extent of sensitivity to chemotherapy is inverse proportion to differentiation degree of gastric cancer; The therapeutic effects of oxaliplatin plus 5-FU plus CF on poorly differentiated, moderately differentiated and well-differentiated gastric cancer patients were indeed.We can use changes of apoptotic index levels of gastric cancer cells of the same patient before and after neoadjuvant chemotherapy to judge the sensitivity of patients to this treatment and then to direct the selection and adjustment of the postoperative chemotherapeutics.