AB32. Effects of XELOX regimen as neoadjuvant chemotherapy on radical resection rate and prognosis in patients with advanced gastric cancer
Qun Zhao, Yong Li, Bi-Bo Tan, Yuan Tian, Zhi-Kai Jiao, Xue-Feng Zhao, Zhi-Dong Zhang, Dong Wang, Pei-Gang Yang
Objective: The purpose of this study was to investigate the efficacy and mechanism of Oxaliplatin in combination with Capecitabine (XELOX) regimen as neoadjuvant chemotherapy in the treatment of patients with advanced gastric cancer.
Methods: Eighty-five patients with advanced gastric cancer (stage IIB and IIIC) were randomly divided into two groups: the neoadjuvant chemotherapy group (test group) and the surgery alone group (control group), with 40 and 45 cases in each group respectively. In test group, patients received oral administration of Capecitabine 2,000 mg/m2 on days 1-14 and intravenous infusion of Oxaliplatin 130 mg/m2 on day 1 (XELOX regimen). The regimen was repeated every 21 days. In control group, patients directly received radical resection of gastric cancer. The R0 resection rate, overall survival and disease free survival (DFS) were observed in every case. The cycles and the apoptosis rate of the gastric cancer cells were detected by using flow cytometry. The expression of proliferating cell nuclear antigen (PCNA), P21, P53 and survivin was detected by using Western blot.
Results: In the test group, the total efficiency was 32.5% (13/40), and the tumor control rate was 90% (36/40), while few side effects occurred. Compared with the control group, R0 resection rate was effectively higher in the test group (P<0.05). The survival analysis indicated that the overall survival and DFS were both longer in the test group in comparison with the control group, but no significant differences were found (P>0.05). In the test group, the apoptosis rate and the ratio of cells in stage G0 and G1 were both significantly higher than the control group (P<0.05). The expression of PCNA and survivin was lower in the test group, while the expression of P21 and P53 was higher.
Conclusions: XELOX regimen, as neoadjuvant chemotherapy in the treatment of patients with advanced gastric cancer, could effectively improve the R0 resection rate and prolong the survival time of the patients. Its mechanism was probably that the neoadjuvant chemotherapy could markedly enhance apoptosis of gastric cancer cells and inhibit their proliferation.
Keywords: Neoadjuvant chemotherapy; gastric carcinoma; prognosis; molecular mechanisms
