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目的探讨进展期胃癌患者新辅助化疗(neoadjuvant chemotherapy,NAC)后行D_2根治术达到病理完全缓解(pathological complete response,pCR)的影响因素。方法进展期胃癌患者132例,采用SOX(奥沙利铂+替吉奥)或XELOX(奥沙利铂+卡培他滨)方案行NAC化疗,每21d为1个周期;化疗2~5个周期后行D_2根治术,手术组织标本行病理检查;多因素logistic回归分析NAC化疗后达到pCR的影响因素。结果 NAC化疗(2.7±1.1)个周期后行D_2根治术,132例中pCR 29例,非pCR 103例;多因素logistic回归分析结果显示,NAC化疗前淋巴结转移(OR=5.871,95%CI:2.091~16.393,P=0.001)是进展期胃癌患者达到pCR的危险因素,NAC化疗>3个周期(OR=0.254,95%CI:0.083~0.779,P=0.017)是进展期胃癌患者达到pCR的保护因素。结论 NAC化疗前无淋巴结转移和NAC化疗>3个周期的进展期胃癌患者更易达到pCR。
Objective To investigate the influencing factors of pathological complete response (pCR) after radical neoadjuvant chemotherapy (NAC) in patients with advanced gastric cancer. Methods Thirty-two patients with advanced gastric cancer were treated with NAC chemotherapy with SOX (oxaliplatin + ticagrelor) or XELOX (oxaliplatin + capecitabine) once every 21 days. Chemotherapy 2 to 5 D_2 radical mastectomy and histopathological examination were performed after the cycle. Multivariate logistic regression analysis was used to analyze the influencing factors of pCR after NAC chemotherapy. Results Twenty-two patients underwent radical resection of D_2 after 2.7 ± 1.1 cycles of NAC chemotherapy. Among 132 patients, pCR was 29 and non-pCR was 103. Multivariate logistic regression analysis showed that lymph node metastasis before NAC (OR = 5.871, 95% CI: (OR = 0.254, 95% CI: 0.083-0.779, P = 0.017) were the risk factors for pCR in patients with advanced gastric cancer (P> 0.05) Protection factors. Conclusion NCR chemotherapy without lymph node metastasis and NAC chemotherapy> 3 cycles of advanced gastric cancer patients more easily reach pCR.