| Background:Gastric cancer remains one of the most common malignancy worldwide, despite the downward trend of incidence in America, Europe and other developed countries. The annual number of new cases is still near one million in the world, with no significant decline in mortality, ranking second among all malignancies. The annual new diagnosed gastric cancer number in china exceed 200 thousand and most of them have been in the advanced period in which the tumor has invaded the serosa or metastasis has taken place, while many patients in Korea and Japan can be diagnosed with early gastric cancer thanks to the policy that huge amount of investment in the general investigation.Currently, surgical resection is still the most important approach in the gastric cancer treatment. The radical gastrectomy combined with D2 lymphatic dissection remains the basis of the cure in gastric cancer. But the prognosis of patients with advanced gastric cancer is still poor with surgical resection alone. In 2006, MAGIC trial confirmed the improvement of perioperative chemotherapy on overall survival and disease-free survival. But some studies have shown that there have been signs of progress during prechemotherapy in a small amount of patients.Therefore,efficacy evaluation of the chemotherapy is of great importance. The TNM works as the gold standard in diagnose, however, pathological regression of the response to chemotherapy is more concrete and objective which has raise more and more attention,but there still exist some controversy when it comes to its method and criteria, so it is worth advanced research and discussion. Therefore we have done some exploration in the efficacy evaluation of neoadjuvant chemotherapy with pathological regression grade.Objectives:A retrospective analysis of advanced gastric cancer patients’pathological response to neoadjuvant chemotherapy and set a new evaluation method in order to investigate the relationship between the pathological tumor regression grade and patients’ prognosis, accumulation of clinical experience if possible.Methods:A retrospective analysis of the clinical and pathological materials of 140 patients diagnosed with advanced gastric cancer and received neoadjuvant chemotherapy in the first affiliated hospital of Zhejiang University from January of 2004 to the June of 2011.Altogether 140 patients mainly received three kinds of chemotherapy regimens: XELOX, FOLFOX and SOX. We evaluated the Pathological tumor regression grade according to the criteria we set,and analyzed the relationship between the TRG and clinicopathological characteristics and survival.Results:Of the 140 patients,55(39.2%) belonged to TRG1,53(37.9%) belonged to TRG2,26(18.6%) belonged to TRG3,and 6(4.3%) belonged to TRG4. Tumor regression grade is significantly associated with postoperative T stage, post-operative lymph node status, tumor differentiation and tumor size. Significant survival difference existed between Notable TRG(TRG3,TRG4) and Non-notable TRG(TRG1+TRG2), while no significant difference existed between TRG1 and TRG2. Postoperative T stage, lymph node status, tumor differentiation tumor size and Notable TRG showed prognosis value in univariate analysis; postoperative stayed the only independent prognostic factor when it comes to the multivariate analysis.Conclusion:It is operable and practical to evaluate the efficacy of chemotherapy with pathological tumor regression grade. Patients who belonged to notable TRG showed a better survival and prognosis than patients who belonged to non-notable TRG. The pathological tumor regression grade could play an important role in the efficacy evaluation and prognosis, though it is not an independent prognostic factor. The postoperative lymph node status is very important in the evaluation of chemotherapy efficacy and prognosis. |
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