新辅助治疗在进展期胃癌中的临床应用效果及对预后的影响

目的探讨新辅助治疗在进展期胃癌中的临床应用效果及对预后的影响。方法选取86例进展期胃癌患者作为研究对象，将其随机分为观察组和对照组，每组43例。观察组患者于术前接受新辅助化疗并于术后接受辅助化疗，对照组患者只在术后接受辅助化疗。对观察组的术前化疗疗效和2组患者的毒性反应、根治性切除率、术后1年复发率和术后2年生存率进行观察和分析。结果观察组患者经过新辅助化疗治疗后，临床有效率达到74．4％，有37例患者（86．0％）进行了胃癌根治性手术，而对照组中有28例患者（65．1％）进行了胃癌根治性手术，观察组行根治性手术的患者比例显著高于对照组（P〈0．05）；观察组行远端胃大部切除术的比例显著高于对照组（P〈0．05）；观察组和对照组患者消化道毒性反应的发生率分别为76．7％和72．1％，差异无统计学意义（P〉0．05）；2组患者出现骨髓抑制反应的比例分别为9．3％和7．0％，差异无统计学意义（P〉O．05），给予对症治疗后均能顺利完成化疗，未发生严重并发症和死亡病例；观察组和对照组患者的术后1年肿瘤复发率分别为11．6％和32．6％，差异有统计学意义（P〈0．05），且观察组患者的肿瘤复发时间显著长于对照组（P〈0．05）；2组患者的2年生存率分别为90．7％和72．1％，差异有统计学意义（P〈0．05）。结论新辅助治疗可有效控制进展期胃癌患者病情的进展，有利于肿瘤的切除，并可显著降低复发率，延缓复发时间并提高生存率，对改善患者预后有积极的作用，且安全性和患者耐受性较高，值得临床推广应用。

Clinical application of neoadjuvant therapy in advanced gastric cancer and its effect on prognosis

Objective To explore the clinical application of neoadjuvant therapy in advanced gastric cancer and its effect on prognosis. Methods Eighty-six advanced gastric cancer patients were selected as research subjects and randomly divided into observation group （n = 43） and control group （ n = 43）. The observation group was treated with preoperative neoadjuvant chemotherapy and the postoperative adjuvant chemotherapy, while the control group was only treated with the ad- juvant chemotherapy after operation. The effects of preoperative chemotherapy of the patients in the observation group and the toxic reactions, radical resection rates, 1-year recurrence rates, the post- operative 2-year survival rates of the two groups were observed and analyzed. Results In the obser- vation group, 43 patients were treated with neoadjuvant chemotherapy treatment and the clinical ef- fectiveness rate was 74.4 %. A total of 37 patients underwent radical operations of gastric cancer, accounting for 86 % of patients in the group, while 28 patients in the control group underwent the radical operation of gastric cancer, accounting for 65.1%. The ratio d the patients in the observa- tion group undergoing the radical operation was significantly higher than that in the control group （P〈 0.05）. The ratio of the patients undergoing the distal gastrectomy in the observation group was higher than that of the control group （ P 〈 0 . 0 5 ） . The ratio of the gastrointestinal toxicity reactions of the patients in the observation group and the control group were 76.7 % and 72.1% respectively and the differences between the two groups were not statistically significant （P 〉0. 05）. The ratio of the bone marrow inhibition of the patients in the two groups patients were 9. 3 % and 7 % respectively and the difference between the two groups was not significant （P 〉 0. 05）. When the symptomatic treatments were given, all the patients could finish the chemothera- py smoothly. No severe complications and deaths were observed. The tumor recurrence rates after 1-year of the patients in the observation group and the control group were 11.6 % and 32.6 % re- spectively and there were significant differences between the two groups （P 〈 0.05）. The time of tumor recurrence in the observation group was significantly longer than that of the control group （P〈0.05）. The 2-year survival rates of the patients in the two groups were 90.7% and 72.1% respectively and the difference between the two groups was statistically significant （ P 〈 0.05 ）. Conclusion The neoadjuvant treatment can effectively control the deterioration of advanced gas- tric cancer, benefit the tumor resection and can significantly reduce the recurrence rate, delay the time to recurrence and improve the survival rate. The treatment plays a positive role in improving the prognosis of patients, has high safety and patient tolerance, and is worthy of the clinical ap- plication.