A Clinical Study Of Different Chemotherapeutic Regimens As First-line Treatment In Advanced Gastric Cancer

Objective: Gastric cancer is one of the most common malignant tumors of Digestive system,threatening human health and survival.The distribution has obvious regional differences,mostly in East Asia.China’s incidence rate of gastric cancer is about 42% of the world.The overall incidence of gastric cancer is the second highest in China.About 600,000 new cases of gastric cancer occur each year,accounting for about 15.82% of all new cancer cases.Whereas,the treatment is limited and the overall prognosis is poor.At present,the only way to cure gastric cancer is still surgery.Due to the imperfect of China’s cancer screening system of gastric cancer and the insidious incidence,early diagnosis rate of gastric cancer is low,only 5%-20%.Most of the patients coming for treatment are advanced gastric cancer,which has no chance to surgery.At this time,surgical treatment alone can not achieve good results,and the recurrence rate is high.In 2016,REGATTA demonstrated,for advanced gastric cancer,combined surgery can not bring survival advantage.For some subtypes,the overall survival is even worse than the simple chemotherapy.Therefore,chemotherapy based comprehensive treatment,which can significantly improve the prognosis of patients and the quality of life,is still the main treatment for patients with advanced gastric cancer.However,because of the high heterogeneity of gastric cancer,there isn’t still standard treatment regimen recommended.Therefore,high efficiency and low toxicity of preoperative chemotherapy regimen is an urgent clinical need.With the development of chemotherapy drugs,the third generation platinum drug(oxaliplatin)has been used more and more in clinical.This study focuses on the clinical efficiency and adverse reactions of FOLFOX regimen(5-fluorouracil + oxaliplatin + Leucovorin),SOX regimen(S1+ oxaliplatin)and TO regimen(Paclitaxel +oxaliplatin)as first-line treatment in advancedgastric cancer,as well as analysis the prognostic factor in patients with gastric cancer.Methods: One-hundred and twelve patients with advanced gastric cancer of IV stage,who admitted to receive chemotherapy the first time in Fourth Hospital of He Bei Medical University from September 1,2009 to December31,2015 were involved in this retrospective study.The patients were divided into three groups according to different chemotherapeutic regimens,which include 33 cases in FOLFOX group,48 cases in SOX group,and 31 cases in TO group.14 indicators recorded,such as gender,age,tumor cases,Karnofsky performance status,histopathological series,tumor marks,cycles of chemotherapy,etc,were collected.The statue of the patient’s survival was followed up by telephone.All the data were processed by SPSS21.0 statistic software.Survival analysis was performed by Kaplan-Meier method and potted survival curves,comparison of survival between three groups was made using the Log-Rank test.Multiple factors analysis was done by Cox proportional hazards regression model,and P value,relative risk,95%confidence intervals were calculated.P < 0.05 was considered statistically significant.Results:1 There were no complete response cases in these three groups.6 patients achieved partial response.18 patients achieved a stable disease,and 9 patients progressed during the course of the treatment in FOLFOX group.The effective rate was 18.2% and the disease control rate was 72.72%.15 patients achieved partial response.23 patients achieved a stable disease,and 10 patients progressed in SOX group.The effective rate was 31.3 % and the disease control rate was 79.16%.8 patients achieved partial response.15 patients achieved a stable disease,and 8 patients progressed in SOX group.The effective rate was 25.8% and the disease control rate was 74.19%.There was no significant difference in the effective rate and the disease control rate between the three groups.2 There were also no differences for PFS(7 m vs.9 m vs.7 m,P=0.527)and OS(12 m vs.12 m vs.11 m,P =0.233).3 The main adverse events included myelosuppression,gastrointestinal reactions and peripheral nerve toxicity,mainly in grade 1-2.There were no statistical differences for peripheral neurotoxicity(9.09% vs.4.2% vs.12.9%)、myelosuppression(24.2% vs.39.6% vs.29.0%).Whereas,the incidence of gastrointestinal reaction of the three groups was 54.5% vs.29.2%vs.51.6%.The incidence of gastrointestinal reaction of group SOX was significantly lower than that of the other groups(P <0.05).4 The KPS score,number of chemotherapy cycle and level of serum CEA were found to be significant predictors of OS by Cox proportional hazards model.Conclusions:1 These three groups of chemotherapy regimens are effective methods for the treatment of advanced gastric cancer.2 Due to the lower adverse reactions,SOX group was better tolerated than the other two groups.3 The KPS score,number of chemotherapy cycle and level of serum CEA were found to be significant predictors of OS.