| Objective: To explore the clinicopathological characteristics and optimal adjuvant chemotherapy regimen of different Lauren classifications in patients with advanced gastric cancer,and to explore the independent risk factors affecting recurrence of gastric cancer post radical operation.Methods: The clinical records and follow-up data of 268 patients with gastric cancer who received D2 radical resection and R0 resection in the fourth Hospital of Hebei Medical University from January 1,2014 to September 30,2016 were retrospectively analyzed.SPSS 23.0,MedCalc 15.8 and GraphPad Prism 7.0 were used for statistical analysis and plotting.First of all,the clinicopathological characteristics of intestinal type and diffuse type gastric cancer were compared,and then the independent risk factors influencing recurrence of gastric cancer post radical operation were screened by multivariate analysis.Finally,the Lauren classification and TNM stage were used for stratification.Independent risk factors for recurrence of gastric cancer with different Lauren classifications and different TNM stages post radical operation were screened.Results:1.Most of intestinal type gastric carcinoma was located in cardia with high histological differentiation,which was related to the high expression of EGFR,HER2,P53,TOPO II and Ki67,the diameter of the tumor was smaller,the positive rate of lymph node was lower,and the proportion of males is more.The diffuse type of gastric cancer was mostly located in the non-cardiac region with low differentiation,which was related to the low expression of EGFR,HER2,P53,TOPO II and Ki67.The diameter of the tumor was larger and the positive rate of lymph nodes was higher,but the proportion of female patients was more than that of intestinal type gastric cancer patients,but the male was still the dominant one.The percentage of elevated CA724 at the first diagnosis of diffuse type was significantly higher than that of intestinal type,and it was more likely to occur nerve invasion and vascular tumor thrombus in diffuse type.2.In the whole cohort,adjuvant chemotherapy regimen,maximum diameter of tumor and positive rate of lymph node were independent risk factors for recurrence of gastric cancer.The risk of recurrence of XELOX regimen post radical operation was 2.323 times as high as SOX regimen.With the increasing of the maximum diameter of the tumor and the positive rate of lymph nodes,the risk of recurrence of gastric cancer increased.In stratified analysis,the risk of recurrence of diffuse gastric cancer post radical operation with XELOX regimen was 2.209 times higher than SOX regimen.The adjuvant chemotherapy regimen is not an independent risk factor for recurrence post radical operation of intestinal type gastric cancer.The risk of recurrence of gastric cancer in stage ? post radical operation with XELOX regimen was 2.161 times higher than SOX regimen.The adjuvant chemotherapy regimen is not an independent risk factor for recurrence post radical operation of gastric cancer in stage ?.3.The positive rate of lymph nodes was an independent risk factor for recurrence of gastric cancer post radical resection,and the independent risk factors for recurrence of gastric cancer with different Lauren classification were different.Conclusions:1.The clinicopathological characteristics,response to adjuvant chemotherapy and independent risk factors affecting prognosis of gastric cancer with different Lauren classification were different.It is of clinical significance to guide individual treatment with Lauren classification.2.SOX regimen can be used as an effective adjuvant chemotherapy,especially in patients with stage ? and diffuse gastric cancer. |
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