| ObjectiveTo explore the feasibility and efficacy of neoadjuvant chemotherapy combined with D2 surgery in elderly patients with locally advanced gastric cancer.MethodsThe clinical and pathological data of 80 patients with locally advanced gastric can cer aged 70-80 years who were diagnosed and treated in our hospital from February 2015 to February 2020 were collected,including age,sex,BMI,combined basic diseases,tumor index,biochemical index,imaging examination,tumor size and location,patholog ical type,chemotherapy scheme,chemotherapy cycle,operation mode,operation time,bleeding volume and drainage volume after operation Divided into control group and study group.Admission method:all patients who received neoadjuvant chemotherapy were re corded and coded from the proposed date,then patients were screened according to the inclusion and exclusion criteria,and the eligible subjects were selected and re-recorded and coded into the study group(neoadjuvant chemotherapy group/N group/NC grou p),and then the cases of the control group(simple operation group/S group/SA group)were collected,and the collection method was to pair with the patients in the study group who had entered the group Patients with gastric cancer within one week before and after surgical treatment in the study group were selected as samples(if there are no patients meeting the standards within one week,the time range should be appropriately expanded,but should not exceed 2 weeks;if there are no suitable matched case s within2 weeks,the corresponding cases in the study group will be removed and recoded;if there are multiple cases in the control group meeting the standards in the same period,the patients with the closest hospitalization days will be selected into th e control group,or all patients with hospitalization days different from those in the same period will be included in the control group).Among them,the intervention method of the study group is mainly neoadjuvant chemotherapy,using XELOX(Oxaliplatin+Capecitabine)chemotherapy scheme.The evaluation of neoadjuvant chemotherapy group is mainly divided into preoperative and postoperative aspects.Preoperative evaluation:1.The patients’clinical tumor staging is performed by CT and other imaging methods before drug intervention,and the patients’tumor staging is judged in the same way after drug intervention.According to the evaluation standard of solid tumor efficacy(version1.1),the tumor remission is divided into 2.According to TRG(Tumor Regressio n Grade)of digestive tract malignant tumor recommended by National Cancer Institute of America,the pathological results of neoadjuvant chemotherapy patients after surgical intervention were evaluated into 0～3 grades.All gastric cancer patients in neoa djuvant chemotherapy group were judged by pathological grade of tumor retreat.The postoperative evaluation mainly includes R0 resection rate,complication rate,cumulative survival rate and other indicators.1.compare the longest diameter of computed tomography(CT)of primary gastric cancer before and after neoadjuvant chemotherapy in the experimental group,and evaluate the clinical effective rate and disease control rate of neoadjuvant chemotherapy.2.Patients in the experimental group wer e evaluated for the efficacy of neoadjuvant chemotherapy combined with postoperative pathological retreat grade.3.The adverse reactions of neoadjuvant chemotherapy were observed and followed up in the experimental group.4.Combined with intraoperative conditions,surgical records and postoperative pathology,the R0 resection rate of the two groups was compared.5.Compare the short-term curative effects of two groups of patients through perioperative safety indicators.6.Compare the long-term survival b enefits of patients through follow-up.Results1.All 30 patients in the study group received preoperative clinical evaluation,including 4 cases of CR,19 cases of PR,6 cases of SD and 1case of PD.The objective response rate ORR was 76.7%(23/30),and the disease control rate DCR was 96.7%(29/30).2.All the 30 patients in the study group obtained evaluable postoperative pathological retreat grades,including 4 cases of TRG0,5 cases of TRG1,9cases of TRG2 and 12 cases of TRG3.Pathological reacti on rate(grade 0～2)was 60%(18/30),and pathological complete remission rate was 13.3%(4/30).3.In this study,19 patients received XELOX scheme and 11 patients received SOX scheme.The adverse reactions of neoadjuvant chemotherapy were hematological tox icity,hepatic insufficiency and gastrointestinal reactions,most of which were grade I-II adverse reactions,which improved after active treatment.One patient WHO received SOX regimen developed severe anemia after two courses of neoadjuvant chemotherapy,which was defined as grade 3 adverse event of chemotherapy according to WHO classification and recovered after active treatment.After discussion by doctors in the treatment group,it was caused by gastrointestinal bleeding caused by tumor progression and toxic side effects of chemotherapy drugs,so neoadjuvant chemotherapy was stopped,total gastrectomy plus D2 lymph node dissection was actively performed,and S-1 was taken orally for one year after operation.There were no death cases related to chemothe rapy.4.All patients in the study group(NC)completed the operation.According to the solid tumor score(RECIST1.1),4 patients were complete clinical remission,19 patients were partial remission,6 patients were stable and 1patient progressed,with a objective response rate of 76.7%and a disease control rate of 96.7%.A total of 28 patients in the study group showed R0resection after operation,and the rate of R0 resection was 93.3%.In the control group(SA),39 patients showed that R0 was resected after operation,and the resection rate of R0 was 78%.The data of the two groups were tested statistically,P=0.048,with significant difference.5.There was no statistical diff erence between the two groups in operation time,intraoperative blood loss,postoperative anal exhaust time,postoperative bed time,postoperative hospital stay,drainage tube removal time,drainage volume three days after operation,time to resume eating,number of lymph node dissection and perioperative rehabilitation index(P>0.05).There is no statistical difference in the incidence of postoperative complications such as postoperative bleeding,incision infection,emptying disorder,anastomotic leakage and intestinal obstruction between the two groups.The incidence of pulmonary infection in 6 cases of study group(NC)was higher than that in 1 case of control group(SA)(P<0.05).There were no deaths during hospitalization in the two groups.6.By the scheduled date of follow-up,78 patients in the study group and the control group had completed the follow-up,while 2 patients in the control group had lost follow-up,with a lost follow-up rate of 4%.The median follow-up time of patients in study group and control group was 28 months(3-60 months)and 29 months(4-54 months),respectively.In the study group,10 patients(33.3%10/30)showed recurrence,recurrence and metastasis,among which 2 patients survived with tumor and 8 patients died.The causes of death included 5 cases of abdominal cavity metastasis,2cases of liver metastasis and 1 case of bone metastasis.Two patients with tumor survival were abdominal metastases.In the control group,29 patients(58%,29/50)had recurrence and metastasis,i ncluding 24 cases of death and5 cases of survival with tumor.The causes of death included abdominal cavity metastasis in 10 cases,liver metastasis in 8 cases,bone metastasis in4 cases,and 2 died of circulatory and respiratory diseases.Kaplan-Meier survival analysis was performed on the study group and the control group,and the total survival analysis curve was drawn.The average total survival time of the study group(N)was 40.382 2.972 months(95%CI:34.558-46.207 months),while that of the contr ol group(S)was 32.759 2.498months(95%)The median survival time of study group(N)was 44 3.245months(95%CI:37.639-50.361 months),while that of control group(S)was 36 3.588 months(95%CI:28.967-43.033 months).Statistical analysis showed thatχ~2=3.976,P=0.046,with significant statistical difference.ConclusionTo sum up,this study holds that:1.Compared with simple operation,the combined treatment has no obvious increase in the risk of operation-related complications,including incision infection,postoperative bleeding,emptying disorder,intestinal obstruct ion and anastomotic leakage.The side effects of chemotherapy in the study group are mostly grade I～II,which can be tolerated and can be recovered after active treatment.This study holds that neoadjuvant chemotherapy will not increase the short-term complications of locally advanced gastric cancer in the elderly;2.In the elderly patients,the combined treatment can significantly improve the resection rate of R0 compared with the simple surgical treatment,and has obvious effect on the pathological ret reat of patients,which can promote the tumor degradation and reduce the tumor volume.3.In the group of elderly patients,combined treatment can significantly improve the survival rate of patients compared with simple surgery,and it is safe and reliable to be a recommended treatment scheme. |
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