| Objective: The aim of this study was to compare the efficacy of paclitaxel liposome based agents first-line chemotherapy and neoadjuvant chemotherapy in advanced gastric cancer to provide a theoretical basis for the comprehensive treatment of gastric cancer.Materials and Methods:1 The comparison of clinical efficacy of Liposomal paclitaxel based chemotherapy and oxaliplatin combined with S-1 in advanced gastric cancer(IIb~IV stage) first-line chemotherapy. 121 patients with advanced gastric cancer of the Fourth Hospital of Hebei Medical University from May 1, 2010 to August 20, 2015 were assigned, which were divided into Paclitaxel liposome group(52 cases) and SOX group(69 cases). The short-term efficacy, progression free survival(PFS), overall survival(OS) and chemotherapy toxicity were analyzed and compared between the two groups. Stratified analysis was carried out by sex, age, ECOG score, primary tumor site, pathological type, tumor markers, hemoglobin level, neutrophil lymphocyte ratio(NLR), platelet lymphocyte ratio(PLR), distant lymph node metastasis and organ metastasis.2 The comparison of clinical efficacy of Liposomal paclitaxel based chemotherapy and oxaliplatin combined with S-1 in advanced gastric cancer(IIb~ IVstage M0) neoadjuvant chemotherapy. 58 patients with advanced gastric cancer of the Fourth Hospital of Hebei Medical University from May 1, 2010 to August 20, 2015 were assigned, which were divided into Paclitaxel liposome group(23 cases) and SOX group(35 cases). The short term efficacy and pathological effects, the disease-free survival(DFS), overall survival(OS) and the toxicity of chemotherapy were analyzed and compared between the two groups. Stratified analysis was carried out by sex, age, pathological type, stage, preoperative neutrophil lymphocyte ratio(NLR), platelet lymphocyte ratio(PLR).Results:1 The results of paclitaxel liposome based chemotherapy and SOX regimen in advanced gastric cancer first-line chemothery. There was no significant difference in ORR(36.54% vs 30.43%, P=0.48), DCR(88.46% vs 88.42%, P=0.992), PFS(6.4m vs 6.3m, P=0.495) and OS(16.1m vs 11.6m, P=0.208) in the two groups. However, the incidence of thrombocytopenia(P=0.04) and liver function damage(P=0.019) in the paclitaxel liposome group was significantly decreased. Stratified analysis showed that in ECOG 0, tumor stage IV before chemotherapy, elevated levels of CEA(CEA, 5ng/m L), low NLR(less than 2.4), low PLR(less than 180) group, paclitaxel liposome group had a longer m OS than group SOX(The P values were 0.008, 0.048, 0.02, 0.01, 0.047, respectively).2 Single factor analysis of patients with advanced gastric cancer first-line chemotherapy using paclitaxel liposome was carried out. The results showed that patients in the group of before chemotherapy NLR ? 2.4(18.9m vs 10.6 m, P = 0.000), before chemotherapy PLR ? 180(18.9m vs 8m; P = 0.02), male(16.6m vs 5.4m; P = 0.027), age > 65 years old(20.6m vs 11.1m; P = 0.025), CA72-4 normal(18.4m vs 11.1m; P = 0.017) had a longer m OS. Multivariate analysis showed that the NLR level before chemotherapy was an independent prognostic factors.3 The results of paclitaxel liposome based chemotherapy regimen and SOX regimen in advanced gastric cancer neoadjuvant chemotherapy. There was no significant difference in ORR(52.17% vs 51.43%, P=0.956), DCR(95.65% vs 94.29%, P=1.000), pathology(15% vs 13.33%, P=1.000), and pathological response rate(55% vs 56.67%, P=0.907) in the two groups. The median DFS and median OS in the two groups were not calculated because the median follow-up time was short. There was no significant difference between the 1, 2, 3 years of disease-free survival and overall survival rate in the two groups. The incidence of hematological toxicity was lower in the paclitaxel liposome group(P=0.043). Stratified analysis showed that in patients with ECOG 0, preoperative NLR > 2.4, preoperative PLR > 130 group, the m OS of paclitaxel liposome group was longer than that of group SOX(The P values were 0.034, 0.041 and 0.006, respectively).Conclusions:1 The efficacy of paclitaxel liposome based chemotherapy was similar to that of SOX regimen in the first-line chemotherapy of advanced gastric cancer. The toxicity of chemotherapy in the paclitaxel liposome group was less. Single factor and multi factor analysis of paclitaxel liposome group showed that the effects in patients with low levels of NLR and PLR before chemotherapy, male, age over 65 years old and normal CA72-4 levels were better. NLR was an independent prognostic factor.2 The efficacy of paclitaxel liposome based chemotherapy was slightly superior to that of SOX regimen in neoadjuvant chemotherapy of advanced gastric cancer. However, chemotherapy toxicity of paclitaxel liposome group was less. It was necessary to expand the sample size to prove its survival benefit. |
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