| Objective: To study the clinical efficacy and safety of fluorouracilbased drugs combined with paclitaxel or oxaliplatin in the clinical treatment of advanced gastric cancer,to observe and compare their survival differences in the treatment of proximal and distal gastric cancer,and to analyze the prognostic factors affecting the survival of advanced gastric cancer through retrospective analysis.Methods: By collecting patients with advanced gastric cancer who visited our oncology department for chemotherapy from January 2018 to January 2021,they were divided into a Observation group(n = 59)and a control group(n = 64)according to the chemotherapy regimen.The Observation group was treated with paclitaxel combined with fluorouracilbased drugs,and the control group was treated with oxaliplatin combined with fluorouracil-based drugs.The progression-free survival(PFS),overall survival(OS),objective remission rate(ORR),disease control rate(DCR)and post-treatment adverse effects were compared between the two groups,and possible prognostic factors were analyzed.Results: The median PFS after treatment was 7.0 months and 6.0months in the Observation group and control group,respectively,with no statistically significant difference(P = 0.850);the median OS was 14.5months and 14.4 months,respectively,with no statistically significant difference(P = 0.303).Further subgroup analysis showed that in proximal gastric cancer the median PFS was 7.5 months and 5.2 months in the Observation group and control group,respectively,with a statistically significant difference(P = 0.043),and the median OS was 13.3 months and13.2 months,respectively,with no statistically significant difference(P =0.369);in distal gastric cancer the median PFS was 5.8 months and 6.5months in the Observation group and control group,respectively,with no statistically significant difference.In distal gastric cancer,the median PFS was 5.8 months and 6.5 months in the Observation group and control group,respectively,with no statistically significant difference(P = 0.140),and the median OS was 14.5 months and 14.6 months,respectively,with no statistically significant difference(P = 0.708).The ORR after treatment was40.7% and 42.2% in the study and control groups,respectively,with no statistically significant difference(P = 0.865);the DCR was 84.8% and87.5%,respectively,with no statistically significant difference(P = 0.658).Both groups experienced adverse reactions after treatment.For hematological toxicity,there was no statistical difference in the incidence of leukopenia,anemia and thrombocytopenia compared(P > 0.05).For nonhematological toxicity,the incidence of alopecia was higher in the Observation group than in the control group at 49.2% vs.9.4%,with a statistically significant difference(P = 0.000),and the incidence of peripheral neurotoxicity was higher in the control group than in the Observation group at 54.7% vs.35.6%,with a statistically significant difference(P = 0.034).The differences in all other adverse reactions were not statistically significant(P > 0.05).A univariate survival analysis of OS for all variables showed that the effects of Eastern Cooperative Oncology Group(ECOG)score,pathology type,Lauren’s staging and clinical stage on OS were statistically significant(P < 0.05).Further COX multifactorial regression model analysis showed that ECOG score(HR = 3.100,95% CI: 1.803-5.330,P < 0.001),type of pathology(HR = 2.385,95% CI: 1.128-5.041,P = 0.023)and Lauren staging(HR = 2.165,95% CI: 1.133-3.179,P = 0.027)were prognostic factors affecting OS.Conclusions: 1.Both treatment regimens were effective and of comparable efficacy in both groups.In the treatment of proximal gastric cancer,the Observation group had longer PFS,but OS did not show the same advantage.2.The incidence of alopecia was higher in the Observation group,and the incidence of peripheral neurotoxicity was higher in the control group,and there was no difference in the comparison of other adverse effects,which were well tolerated in both groups.3.Multifactorial survival analysis showed that ECOG score,type of pathology,and Lauren’s staging were independent prognostic factors affecting the survival of patients with advanced gastric cancer. |
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