POF方案新辅助化疗联合腹腔镜D_(2)根治术在局部进展期胃癌中的应用及预后价值分析

Application and Prognostic Value of POF Neoadjuvant Chemotherapy Combined with Laparoscopic D_(2) Radical Resection in Patients with Locally Advanced Gastric Cancer

目的:研究POF方案新辅助化疗(NCT)联合腹腔镜手术在局部进展期胃癌(LAGC)中的临床疗效及对预后的影响。方法:回顾性分析2015年1月-2019年6月福建医科大学附属福州市第一医院普外科收治的56例LAGC行NCT治疗患者的临床资料,根据新辅助化疗方案不同分为POF方案+腹腔镜下D_(2)根治术组(试验组,n=21)和XELOX/SOX方案+腹腔镜下D_(2)根治术组(对照组,n=35)。分析比较两组患者的化疗后效果及不良反应、围手术期临床指标、术后并发症发生率及预后情况。结果:试验组客观缓解率(ORR)及疾病控制率(D_(2)CR)均高于对照组(61.90%vs.34.29%,90.48%vs.65.71%),差异均有统计学意义(P=0.044、0.038);两组各血液/非血液学毒性不良反应发生率方面比较,差异均无统计学意义(P>0.05);在围手术期临床指标方面,试验组肿瘤平均直径小于对照组,差异有统计学意义(P=0.027);试验组中肿瘤退缩分级0~1级患者占比高于对照组,差异有统计学意义(P=0.042);试验组中ypT_(1+2)、ypT_(3+4)分别为12例(57.14%)、9例(42.86%),对照组分别为10例(28.57%)、25例(71.43%),差异有统计学意义(P=0.034);试验组根治性切除率(R0切除率)为95.24%,高于对照组的85.71%,但差异无统计学意义(P>0.05);两组在手术方式、手术时间、术中出血量、清扫淋巴结数目及ypN分期方面比较,差异均无统计学意义(P>0.05);两组患者中ClavienD_(2)indo分级为Ⅰ~Ⅱ级和Ⅲ~Ⅳ级的并发症发生率比较,差异均无统计学意义(P>0.05);试验组患者的3年生存率高于对照组(47.62%vs.31.43%),差异有统计学意义(χ^(2)=5.273,P=0.022)。结论:LAGC患者行POF方案NCT治疗,可降低肿瘤分期,改善患者预后,且并不提高不良反应及围手术期并发症发生率。

Objective:To investigate the clinical efficacy and prognosis of POF neoadjuvant chemotherapy(NCT) combined with laparoscopic surgery in locally advanced gastric cancer(LAGC).Method:The clinical data of 56 patients with LAGC who received NCT from January 2015 to June 2019 in Surgery D_(2)epartment of Affiliated Fuzhou First Hospital of Fujian Medical University were retrospectively analyzed.According to different NCT regimens,they were divided into POF regimen + laparoscopic D_(2)radical group(trial group,n=21) and XELOX/SOX regimen + laparoscopic D_(2)radical group(matched group,n=35).The efficacy and adverse reactions after chemotherapy,perioperative clinical indicators,postoperative complications and prognosis of the two groups were analyzed and compared.Result:The objective response rate(ORR) and disease control rate(D_(2)CR) of the trial group were higher than those of the matched group(61.90% vs.34.29%,90.48% vs.65.71%),the differences were statistically significant(P=0.044,0.038).There were no significant differences between the two groups in the incidences of hematological/non-hematological toxic adverse reactions(P>0.05).In terms of perioperative clinical indicators,the average tumor diameter of the trial group was smaller than that of the matched group,the difference was statistically significant(P=0.027);the proportion of patients with tumor regression grades of 0-1 in the trial group was higher than that in the matched group,with a statistically significant difference(P=0.042);in the trial group,there were 12 cases(57.14%) of ypT_(1+2) and 9 cases(42.86%) of ypT_(3+4),respectively,while in the matched group,there were 10 cases(28.57%) and 25 cases(71.43%),respectively,with a statistically significant difference(P=0.034);the R0 resection rate in the trial group was 95.24%,higher than 85.71% in the matched group,but the difference was not statistically significant(P>0.05).There were no significant differences in surgical methods,operation time,intraoperative bleeding,ypN stage and number of lymph node dissections between the two groups(P>0.05);there were no statistically significant in the complication rates of Clavien-D_(2)indo grades Ⅰ-Ⅱ and Ⅲ-Ⅳ between the two groups(P>0.05);the 3-year survival rate of the trial group was higher than that of the matched group(47.62% vs.31.43%),the difference was statistically significant( χ^(2)=5.273,P=0.022).Conclusion:NCT with POF regimen can reduce tumor staging and improve prognosis of patient without increasing the incidence of adverse reactions and perioperative complications.