| Objective: To explore the clinical efficacy and prognosis of conversion therapy and chemotherapy alone in patients with stage Ⅳ gastric cancer.Methods: A retrospective study was conducted on 78 patients with stage Ⅳ gastric cancer who were initially unresectable in the 900 th Hospital of Joint Logistic Support Force from January 2013 to December 2017.According to the results of 2-4 cycle chemotherapy,78 patients with stage Ⅳ gastric cancer were divided into two groups: conversion group(n = 33)and chemotherapy alone group(n = 45).Patients in the conversion group underwent total gastrectomy,distal or proximal gastrectomy after chemotherapy.The patients in the chemotherapy alone group only received chemotherapy and no other special adjuvant therapy.The observation contents were as follows:(1)the efficacy of chemotherapy was evaluated according to the solid tumor efficacy evalu ation criteria(RECIST 1.1),and the side effects of chemotherapy were evaluated according to the National Institute of Cancer Research-adverse events General terminology Standard(NCI-CTCAE 4.0).(2)the operation time,intraoperative blood loss,postoperative hospital stay and postoperative complications of patients undergoing conversion hand resection.(3)the disease-free survival time and overall survival time of the patients were obtained by telephone follow-up,outpatient revisit and hospitalization reexamination.(4)to analyze the factors affecting the prognosis of patients with unresectable stage Ⅳ gastric cancer.Cumulative survival rate was calculated by Kaplan-Meier method,survival curve was analyzed by Log-rank test,univariate and multivariat e analysis were performed by Cox proportional hazard regression model,and independent prognostic factors were explored.Results:(1)According to different chemotherapy regimens,78 patients were divided into three-drug combination regimen(n = 25)and t wo-drug combination regimen(n = 53).The number of preoperative chemotherapy cycles was 4(2 ～ 8)and the total number of chemotherapy cycles was 6(4～ 18).Evaluation of the effect of chemotherapy: 31 cases of partial remission,36 cases of disease stab ility,11 cases of disease progression,after chemotherapy,the overall remission rate was 39.7%,and the disease control rate was 85.9%.During the period of chemotherapy,28 patients had no chemotherapy complications,18 patients had nausea and vomiting,and 32 patients had myelosuppression,of which 11 patients had third-degree or fourth-degree myelosuppression.In the conversion treatment group,there were 2 cases of third-degree or fourth-degree myelosuppression in the two drugs regimen and 3 cases in the three drug regimens.(2)Among the 33 patients undergoing conversion therapy,distal subtotal gastrectomy plus Billroth Ⅱ anastomosis was performed in 4 cases(12%),proximal gastrectomy plus gastroesophageal anastomosis in 1 case(3%),and total gastrectomy plus Roux-en-Y digestive tract reconstruction in 28 cases(85%).The intraoperative blood loss(mL)was 200(50～540),the operation time(min)was 170(120 ～260),and the postoperative hospital stay(days)was 10(7～23),of which 12 patients underwent R0resection(36.4%)and 21 patients underwent R1/R2 resection(63.6%).Postoperative complications occurred in 3 pa tients,including grade Ⅲ a pleural effusion in 1 case,jejunal anastomotic bleeding in 1 case,and grade Ⅱ incision infection in 1 case.(3)the overall median survival time of 78 patients was 15 months,the median survival time of 33 patients in the conversion group(i.e.chemotherapy + gastrectomy)was 19 months,and the median survival time of 45 patients in the chemotherapy alone group was 13 months.The median PFS of the conversion group was 12 months,and that of the chemotherapy alone group was 8 months.The difference was statistically significant(P< 0.05).Of the 33 patients who received conversion therapy,12 patients(36%)who underwent R 0resection had a 1-and 2-year survival rate of 91.7% and 58.3%,respectively,while 21 patients(64%)who un derwent R1/R2 resection had a 1-and 2-year survival rate of 52.4% and 0%,respectively.Patients who underwent R0 resection survived longer than those who underwent R1/R2 resection.The 1-year and 2-year survival rates of the two-drug chemotherapy regimen were 75% and 20%,respectively,and the 1-year and 2-year survival rates of the three-drug chemotherapy regimen were92.3% and 53.8%,respectively.(4)Cox proportional model univariate analysis showed that surgical resection,R0 resection,single factor the16 th lymph node metastasis and metastasis site were significantly correlated with survival time.Multivariate analysis showed that R0 gastrectomy was a protective factor for the prognosis of patients with stage Ⅳ gastric cancer.Conclusion: R0 resection is a prognostic factor for long-term survival of stage Ⅳ gastric cancer.There was no difference in survival time between three drugs combined chemotherapy and two drugs combined chemotherapy. |
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