| Background:Worldwide,gastric cancer(GC)is the fifth most common cancer with more than 1 million new cases per year and the third leading cause of cancer death 1.The overall prognosis of gastric cancer is poor,and less than a quarter of patients in Western countries can achieve long-term survival.At present,the only curative treatment for advanced gastric cancer is still surgical treatment.Advanced gastric cancer will infiltrate into the submucosa,enter or have passed through the serosa,invade lymph nodes and spread to adjacent tissues or metastasize to other organs2,3.Translational therapy is part of multidisciplinary treatment,and theoretically translational therapy can downstage gastric cancer clinic4,5.Therefore,translational therapy has gradually become a hot spot in the treatment of gastric cancer.At present,the clinical therapeutic effect of translational therapy for locally advanced gastric cancer at home and abroad,as well as the standard chemotherapy regimen of translational therapy are still controversial.In this study,we investigated the overall response rate and adverse reactions of chemotherapy in patients with advanced gastric cancer who underwent conversion therapy with paclitaxel,oxaliplatin and fluorouracil regimen and patients with advanced gastric cancer who received postoperative adjuvant chemotherapy with this regimen,and compared the radical resection rate(R0 resection rate)and short-term prognosis of surgery in the conversion therapy group,providing new suggestions for the treatment of locally advanced gastric cancer.ObjectiveThe aim of this paper was to investigate the effect of translational therapy withpaclitaxel,oxaliplatin and fluorouracil on the overall efficiency of chemotherapy,adverse reactions,radical resection rate.To investigate the value of translational therapy with paclitaxel,oxaliplatin and fluorouracil in locally advanced gastric cancer.Materials and methods:This study was a retrospective study.A total of 25 patients with advanced gastric cancer(clinical stage IIIA/IIIB)who received translational therapy with paclitaxel,oxaliplatin and fluorouracil in the Department of Oncology,Shandong Provincial Hospital from January 2015 to June 2019 were selected as study group and enrolled in the case review system of Shandong Provincial Hospital.Clinical stage IIIA/IIIB and paclitaxel,oxaliplatin and fluorouracil as postoperative adjuvant chemotherapy were collected,and these patients served as the control group.The experimental group was treated with Lipitor 135 mg/m2 dl ivdrip+oxaliplatin 85 mg/m2 d1 ivdrip+leucovorin 400 mg/m2 dl ivdrip+5-FU 2400 mg/m2 civ46h regimen every course,repeated every 2 weeks.Efficacy was evaluated after 2 cycles of translational therapy,and objective response was evaluated according to RECIST 1.0(Response Evaluation Criteria in Solid Tumors).Radical gastrectomy was performed after 2 cycles of paclitaxel,oxaliplatin and fluorouracil chemotherapy.If progressive disease(PD)was evaluated,MDT decided whether to perform direct surgical treatment,and a total of 10-12 cycles of paclitaxel,oxaliplatin and fluorouracil.The control group directly underwent standard radical gastrectomy,followed by 10-12 cycles of paclitaxel,oxaliplatin and fluorouracil chemotherapy.Radical gastrectomy for gastric cancer is based gastrectomy,or total gastrectomy++D2 lymphadenectomy.To observe the short-term efficacy,adverse reactions,postoperative pathology and R0 resection rate between the two groups of translational therapy in the experimental group.The overall survival(OS)and disease-free survival(DFS)of the control group were compared during follow-up.The specific evaluation indicators are as follows:1.according to RECIST criteria,evaluate the objective efficacy of translational therapy in the experimental group;2.observe the adverse reactions during chemotherapy in the experimental control group;3.compare the R0 resection rate between the experimental control group according to the intraoperative findings and postoperative pathological conditions;4.compare the OS and DFS differences in the experimental control group by follow-up.Result:1.Of the 25 patients in the test group,0 had CR and 16 had PR,with a clinical response rate(CR+PR)of 64.0%.Eight patients(32.0%)had SD and 1(4.0%)had PD,with a tumor control rate(CR+PR+SD)of 96.0%.2.The adverse reactions of paclitaxel,oxaliplatin combined with fluorouracil chemotherapy included nausea and vomiting,leukopenia,thrombocytopenia,diarrhea,abnormal liver function,and peripheral neuritis.There were no deaths from chemotherapy(see Figure2).3.Twenty-three of the 25 patients in the experimental group underwent gastrectomy with D2 lymph node dissection,of which 2 patients failed to undergo surgery due to disease progression.In the test group,RO resection was performed in 21 cases,with RO resection rate of 91.3%and R1 resection in 2 cases(8.7%).There were no patients with R2 resection.In the control group,RO resection was performed in 26 patients,with an RO resection rate of 86.6%and R1 resection in 4 patients(13.3%).Postoperative pathology reported positive residual tumor at the upper resection margin in 3 cases and positive residual tumor at the lower resection margin in 1 case.The RO resection rate was higher in the test group than in the control group,.4.The mean OS in the experimental group was 38.5 months(95%CI 32.683-43.452).The mean OS in the control group was 32.2 months(95%CI 27.380-35.143).The mean OS was higher in the test group than in the control group,but the difference was not statistically significant(P=0.231)(see Figure 3).The mean DFS in the experimental group was 38.1 months(95%CI 32.682-43.153).The mean DFS in the control group was 31.2 months(95%CI 26.158-37.243).The mean DFS was higher in the test group than in the control group,but the difference was not statistically significant(P=0.356)(see Figure4).Conclusion:1.paclitaxel,oxaliplatin and fluorouracil has a high clinical response rate and tolerable adverse reactions;2.paclitaxel,oxaliplatin and fluorouracil can improve the RO resection rate of radical gastrectomy for gastric cancer and benefit patients;3.The survival time of patients treated with translational therapy with paclitaxel,oxaliplatin and fluorouracil is not inferior to that of patients treated with conventional postoperative chemotherapy. |
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