| Objective:To explore the clinical value of using carbon nanoparticles suspension injection(CNSI)to improve the accuracy of lymph node staging of neoadjuvant chemotherapy for advanced gastric cancer.Methods:A total of 180 patients with advanced gastric cancer who underwent preoperative neoadjuvant chemotherapy from January 2018 to January 2019 in the Fourth Hospital of Hebei Medical University were enrolled.The random number table method was used to divide all patients into experimental group,control group and blank control group,with 60 cases in each group.The patient in the experimental group was injected with CNSI within 24 hours before neoadjuvant chemotherapy,the patient in the control group was injected with CNSI within 24 hours before surgery,and the patient in the blank control group was not injected with CNSI.All patients enrolled received four cycles of oxaliplatin plus capecitabine chemotherapy(CapeOX regimen).All patients underwent radical gastrectomy for D2 after neoadjuvant chemotherapy.The total number of lymph nodes detected,the total number of stained lymph nodes and the total number of tiny lymph nodes(d<2 mm)were recorded,and the lymph node staining rate,lymph node metastasis rate,stained lymph node metastasis rate,postoperative complication rate and lymph node staging were analysed.Results:1.There were no significant differences in baseline data and surgical related data(age,gender,BMI,tumor location,tumor longest diameter,cTNM stage,histological type,differentiation degree,surgical range and tumor regression grading)among the three groups(P>0.05).2.Total number of lymph nodes detected:3174 lymph nodes were detected in the experimental group,2468 lymph nodes were detected in the control group,and 1925 lymph nodes were detected in the blank control group.The number of mean lymph nodes detected:experimental group(52.90±10.42),control group(41.13±8.43),blank control group(32.08±9.78),The difference between the three groups(F=71.27,P=0.00)was statistically significant.3.Total number of stained lymph nodes:There were 1885 stained lymph nodes in the experimental group and 1274 stained lymph nodes in the control group.The average of the experimental group was(31.42±9.25),which was higher than that of the control group(21.23±8.91).There was a significant difference(t=6.83,P=0.00).The lymph node staining rate of the experimental group(59.39%)was significantly higher than that of the control group(51.62%),and the difference(?~2=34.00,P=0.00)was statistically significant.4.The number of tiny lymph nodes detected:(10.52±3.38)in the experimental group,(8.23±2.68)in the control group,and(6.55±2.30)in the blank control group,the difference(F=29.88,P=0.00)was significant.5.Lymph node metastasis rate:The lymph node metastasis rate of the experimental group was 14.21%(451/3174),which was slightly higher than the control group(13.65%(337/2468)).The difference(?~2=0.36,P=0.56)was not statistically significant.The difference between the experimental group and the blank control group was 9.35%(180/1925),and the difference(?~2=26.09,P=0.00)was statistically significant.The difference of lymph node metastasis rate between the control group and the blank control group was statistically significant(?~2=19.26,P=0.00).6.The rate of lymph node metastasis was 18.83%(355/1885)in the experimental group and 17.43%(222/1274)in the control group.The difference between the experimental group and the control group(?~2=1.01,P=0.32)was not statistically significant.The unstained lymph node metastasis rate of the experimental group was 7.45%(96/1289),the stained lymph node metastasis rate was 18.83%(355/1885),and the difference(?~2=71.43,P=0.00)was statistically significant.In the control group,the rate of unstained lymph node metastasis was 9.63%(115/1194),and the rate of lymph node metastasis was 17.4%(222/1274).The difference(?~2=31.76,P=0.00)was statistically significant.7.Lymph node staging:experimental group pN0 was 6 cases,pN1 was 5cases,pN2 was 16 cases,pN3 was 33 cases,control group pN0 was 3 cases,pN1 was 7 cases,pN2 was 31 cases,pN3 was 19 cases,blank The control group had 15 cases of pN0,20 cases of pN1,16 cases of pN2,and 9 cases of pN3.The difference of pN in the three groups was statistically significant(?~2=4.63,P=0.00).8.Complications:There was no significant difference in the incidence of postoperative bleeding,pulmonary infection,postoperative incision infection,anastomotic leakage and intestinal obstruction between the experimental group,the control group and the blank control group(P>0.05).Conclusions:1.Preoperative application of CNSI in patients with advanced gastric cancer with neoadjuvant chemotherapy can significantly improve the accuracy of lymph node staging after neoadjuvant chemotherapy.2.The application of CNSI before neoadjuvant chemotherapy in patients with advanced gastric cancer can reduce the effect of neoadjuvant chemotherapy on lymph node detection,reduce the lymph node staging bias after neoadjuvant chemotherapy,and improve the accuracy of lymph node staging after neoadjuvant chemotherapy. |
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