Effects Of Two Different Neoadjuvant Chemotherapy Regimens On Clinical Efficacy And Perioperative Period Of 227 Patients With Locally Advanced Gastric Cancer

Objective: The incidence of gastric cancer ranks fifth in the world,while the mortality rate ranks third in the cause of cancer death.About half of every 1 million new cases of gastric cancer in the world are Chinese.At present,surgery is still the main treatment method for gastric cancer patients in China.Because the diagnosis rate of early gastric cancer is low,once it is found,most of the patients become locally advanced gastric cancer(LAGC),the results of surgical treatment and prognosis are often not a satisfactory curative effect.Compared with simple operation,preoperative neoadjuvant chemotherapy(NACT)can significantly increase the intraoperative R0 resection rate,improve the prognosis and prolong the overall survival time.At present,commonly used neoadjuvant chemotherapy regimens include ECF,ECX,SOX and so on,including epirubicin,platinum and fluorouracil.In view of the fact that paclitaxel drugs have been proved to be effective in advanced gastric cancer by several groups of clinical studies recently,this paper intends to compare the clinical efficacy and perioperative effects of XELOX and SOX regimens dominated by oxaliplatin combined with fluorouracil regimens and DS and XT regimens dominated by docetaxel combined with fluorouracil regimens.Methods: A total of 227 patients with locally advanced gastric cancer in the first affiliated Hospital of China Medical University from January 2010 to December 2018 were collected.There were 75 patients with oxaliplatin combined with fluorouracil and 152 patients with docetaxel combined with fluorouracil.They were named oxaliplatin group and docetaxel group respectively.The clinical efficacy of all patients before and after 2 cycles of neoadjuvant chemotherapy were evaluated by RECIST1.1 evaluation method.At the same time,the toxic and side effects and the changes of 6 related tumor markers before and after chemotherapy were evaluated according to blood biochemical indexes.Compare the overall operation rate with that of the two groups.A comparative study of pathological yp TNM staging after neoadjuvant therapy was performed in 107 patients who received surgical treatment after NACT.The R0 resection rate and lymph node dissection rate of the two groups were recorded.All patients were followed up to evaluate their prognosis and survival.The RECIST1.1 method was also used to record the evaluation results for the patients who received 1 or 2 cycles of chemotherapy after 2 cycles to explore whether the effect was further improved with the prolongation of the chemotherapy cycle.Results: According to RECIST1.1 analysis,the disease remission rates of oxaliplatin group and docetaxel group were 48% and 30.7%,respectively,and the disease control rates were 93.3% and 95.4%,respectively.A total of 95 cases of myelosuppression occurred during NACT,and the incidence rates of the two groups were 52% and 36.8%,respectively.There were differences between CEA and CA724 in tumor markers.A total of 107 patients underwent surgery after chemotherapy,accounting for 47.1% of the total.The operation rates of the two groups were 52% and 44.7% respectively,and the difference was not statistically significant.Compared with the yp TNM stage after neoadjuvant therapy,there were 48 patients with p CR,stage ? and stage ?,accounting for 45.28%.There was no significant difference in yp TNM and yp T stages between the two groups.The R0 resection rates of the two groups were 76.9% and 92.6%,respectively.The lymph node dissection rates of the two groups were 82.1% and 95.6%,respectively.The overall and median survival time between the two groups was 34 months.After 2 cycles of chemotherapy,the average tumor retraction rate increased from 28.3% to 38.43%.Conclusion: Paclitaxel combined with fluorouracil as a neoadjuvant chemotherapy regimen for locally advanced gastric cancer has better disease remission rate,and the incidence of adverse reactions to chemotherapy is less.The resection rate and lymph node dissection rate were improved compared to the oxaliplatin group,which is worth popularizing in clinical practice.