Abstract
BackgroundSurgery combined with postoperative chemotherapy is an effective method for treating patients with gastric cancer (GC) in Asia. The important roles of systemic inflammatory response in chemotherapy have been gradually verified. The purpose of this study was to assess the difference in clinical effectiveness of FOLFOX (oxaliplatin + leucovorin + 5-fluorouracil) and XELOX (oxaliplatin + capecitabine), and the prognostic value of postoperative platelet–lymphocyte ratio (PLR) in the XELOX group.MethodsPatients who received radical gastrectomy combined with postoperative chemotherapy between 2004 and 2014 were consecutively selected into the FOLFOX and XELOX groups. Group bias was reduced through propensity score matching, which resulted in 278 patients in each group. Cut-off values of systemic immune inflammation (SII) score and PLR were obtained by receiver operating characteristic curve. Kaplan–Meier and Log-rank tests were used to analyze overall survival. The chi-square test was used to analyze the association between clinical characteristics and inflammatory indexes. Univariate and multivariate analyses based on Cox regression analysis showed independent risk factors for prognosis. The nomogram was made by R studio.ResultsPatients receiving XELOX postoperative chemotherapy had better survival than those receiving FOLFOX (P < 0.001), especially for stage III GC (P = 0.002). Preoperative SII was an independent risk factor for prognosis in the FOLFOX group, and PLR of the second postoperative chemotherapy regimen in the XELOX group, combined with tumor size and pTNM stage, could construct a nomogram for evaluating recurrence and prognosis.ConclusionXELOX is better than FOLFOX for treatment of GC in Chinese patients, and a nomogram constructed by PLR, tumor size and pTNM stage can predict recurrence and prognosis.
Highlights
Gastric cancer (GC) is the third most common cause of cancer mortality worldwide, and causes 723,000 deaths each year according to the International Agency for Research on Cancer (IARC) in 2012
We found that systemic immune inflammation (SII) score was an independent risk factor for prognosis in the FOLFOX group and platelet–lymphocyte ratio (PLR) in the second time of XELOX postoperative chemotherapy regimen was an independent predictor using the Cox risk regression model, which could evaluate the clinical efficacy of the corresponding treatment
We found that high PLR had a significant association with tumor size and pTNM stage through the chi-square test, which was related to deeper tumor invasion, and presence of local lymph node metastasis, and a distant metastasis
Summary
Gastric cancer (GC) is the third most common cause of cancer mortality worldwide, and causes 723,000 deaths each year according to the International Agency for Research on Cancer (IARC) in 2012. In the selection of postoperative chemotherapy regimens, FOLFOX (oxaliplatin + leucovorin + 5fluorouracil) and XELOX (oxaliplatin + capecitabine) are common regimens that have been widely used clinically after decades of clinical research [4]. The high degree of heterogeneity of GC affects the clinical efficacy of different chemotherapy regimens. There is still a lack of data demonstrating the feasibility of which chemotherapy regimen is more suitable for Chinese patients after radical gastrectomy. Surgery combined with postoperative chemotherapy is an effective method for treating patients with gastric cancer (GC) in Asia. The purpose of this study was to assess the difference in clinical effectiveness of FOLFOX (oxaliplatin + leucovorin + 5-fluorouracil) and XELOX (oxaliplatin + capecitabine), and the prognostic value of postoperative platelet–lymphocyte ratio (PLR) in the XELOX group
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
