ObjectiveTo compare the clinical effects of continuous hyperthermic peritoneal perfusion chemotherapy (CHPPC) and intravenous chemotherapy for advanced gastric cancer patients, and find better nursing methods. MethodsSixty advanced gastric cancer patients who underwent chemotherapy between June 2013 and June 2014 were divided into CHPPC group (group C, n=30) and intravenous chemotherapy group (group V, n=30). We recorded the nursing methods for both the two groups, patients' satisfaction to the nursing and treatment, peritoneal metastasis rate and quality of life during the chemotherapy. ResultsThe life quality in group V was lower than that in group C (P<0.05). The differences in patients' satisfaction rate, peritoneal metastasis rate, and one-year survival rate were not significantly different between the two groups (P>0.05). ConclusionFor patients with advanced gastric cancer requiring chemotherapy, in spite of higher cost and more complicated operations, CHPPC is superior in lower adverse events rate, better quality of life during chemotherapy and doesn't decrease patients' satisfaction to the nursing and treatment.
Objective To systematically evaluate the safety and efficacy of trastuzumab combined with chemotherapy for HER-2 positive patients with advanced gastric cancer. Methods We searched ClinicalTrails.gov, PubMed, EMbase, Web of Science, The Cochrane Library (Issue 5, 2016), CNKI, CBM, WanFang Data, VIP and major meeting proceeding databases (ASCO and ESMO) from inception to May 2016, to collect randomized controlled trials (RCTs) or non-RCTs about trastuzumab combined with chemotherapy versus chemotherapy alone for advanced gastric cancer. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was performed by using RevMan 5.3 software. Results Nine studies involving 1 034 HER-2 positive patients were included, of which three were RCTs and the other six were non-RCTs. Meta-analysis results indicated that the trastuzumab combined with chemotherapy group (the trial group) was superior to the chemotherapy alone group (the control group) in complete remission (OR=2.76, 95%CI 1.40 to 5.44,P=0.003), partial remission (OR=1.81, 95%CI 1.40 to 2.33,P<0.000 01), overall response rate (OR=2.09, 95%CI 1.63 to 2.68,P<0.000 01) and disease control rate (OR=2.20, 95%CI 1.63 to 2.98,P<0.000 1), while there was no statistical significances in stable disease (OR=0.87, 95%CI 0.66 to 1.14,P=0.31). In terms of safety, the incidence of diarrhea (OR=1.51, 95%CI 1.10 to 2.06,P=0.01) and erythra (OR=4.35, 95%CI 1.25 to 15.10,P=0.02) in the trial group were higher than the control group. However, other adverse reactions were no significant differences in two groups. Conclusion Compared with chemotherapy alone, trastuzumab combined with chemotherapy in the treatment of HER-2 positive patients with advanced gastric cancer can significantly improve response rate, but it may increase the incidence of diarrhea and erythra. Because of the limited quality and quantity of the included studies, the above conclusion needs to be verified by conducting more high quality studies.
Objectives To systematically review the efficacy and safety of docetaxel or epirubicin based regimens in the treatment of advanced gastric cancer. Methods We searched EMbase, PubMed, The Cochrane Library, Web of Science, CBM, CNKI and WanFang Data from inception to March 2017, to collect randomized controlled trials (RCTs) on docetaxel or epirubicin based regimens in the treatment of advanced gastric cancer. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed by using RevMan 5.3 software. Results A total of 12 RCTs involving 984 advanced gastric cancer patients were included. The results of meta-analysis showed that docetaxel based regimens were superior to epirubicin based regimens in ORR (RR=1.21, 95%CI 1.02 to 1.43, P=0.03), DCR (RR=1.13, 95%CI 1.01 to 1.26, P=0.03), 1-year survival rate (RR=1.26, 95%CI 1.01 to 1.56, P=0.04) and 2-year survival rate (RR=3.03, 95%CI 1.59 to 5.75, P=0.000 7), while there was no statistical difference between two groups in the incidence of grade Ⅲ to Ⅳ adverse events. The results of sensitivity analysis showed that docetaxel based regimens were superior to epirubicin based regimens in 2-year survival rate (RR=2.56, 95%CI 1.06 to 6.19, P=0.04), but there were no statistical differences in ORR (RR=1.13, 95%CI 0.88 to 1.45, P=0.34), DCR (RR=1.02, 95%CI 0.85 to 1.21, P=0.84) and 1-year survival rate (RR=1.29, 95%CI 0.92 to 1.80, P=0.14). The results of sensitivity analysis indicated that the overall outcomes might be affected by the risk bias of included studies. The comparision between docetaxel based regimens and epirubicin based regimens was consistent with the overall outcomes in the incidence of grade Ⅲ to Ⅳ adverse events. Conclusions Compared with epirubicin based regimens, docetaxel based regimens may have more clinical benefits for advanced gastric cancer patients. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo summarized the clinical experience on laparoscopic radical surgery in patients with advanced distal gastric cancer. MethodsThe clinical data of 26 patients with advanced distant gastric cancer undergoing laparoscopic gastrectomy were retrospectively analyzed. ResultsLaparoscopic distal gastrectomy was performed successfully in all patients. The operation time was (283.2±27.6) min (270-450 min) and the blood loss was (178.4±67.4) ml (80-350 ml). The time of gastrointestinal function recovery was (2.8±1.2) d (2-4 d), out of bed activity time was (1.5±0.4) d (1-3 d) and liquid diet feeding was (3.5±1.4) d (3-4 d). The hospital stay was (10.0±2.6) d (7-13 d). The number of harvested lymph nodes was 11 to 34 (17.8±7.3). The distance from proximal surgical margin to tumor was (7.0±2.1) cm (5-12 cm) and the distance from distal surgical margin to tumor was (5.5±1.8) cm (4-8 cm), thus surgical margins were negative in all samples. All patients were followed up for 3-48 months (mean 18.5 months), two patients with poorly differentiated adenocarcinoma died of extensive metastasis in 13 and 18 months, respectively, and other patients survived well. ConclusionsLaparoscopic radical gastrectomy with D2 lymphadenectomy for advanced gastric cancer is safe and feasible. However, the advantage of laparoscopic technique over the conventional open surgery requires further study.
ObjectiveTo summarize the research progress of neoadjuvant chemotherapy in advanced gastric cancer. MethodThe literatures about the research progress of neoadjuvant chemotherapy in the advanced gastric cancer were reviewed. ResultsThe neoadjuvant chemotherapy in the advanced gastric cancer could significantly improve the R0 resection rate, improve the long-term survival rate, and reduce the risk of death.The course of neoadjuvant chemotherapy for locally advanced gastric cancer without distant metastasis generally was 6-9 weeks, and then according to the results of the curative effect evaluation to decide whether to undergo surgery treatment.Further the clinical research and improvement of chemotherapy sensitivity detection method were helpful to the unity of the standard of neoadjuvant chemotherapy. ConclusionsThe curative effect of neoadjuvant chemotherapy in advanced gastric cancer is clear.But there is no uniform standard on such as indications, chemotherapy regimens, medication time, and curative effect evaluation index, and so on.It is still needed the further research of multicenter and large clinical trials.
ObjectiveTo compare the effect and safety between laparoscopic versus laparotomy D2 radical gastrectomy for advanced gastric cancer. MethodsTwo hundred and seventeen patients with advanced gastric cancer who were treated in our hospital from March 2011 to March 2014 were selected as research objects. According to surgical method, they were divided into laparoscopy group (103 patients received laparoscopic D2 radical gastrectomy) and laparotomy group (114 patients received laparotomy D2 radical gastrectomy). Comparison of the surgical effect-related indicators between 2 groups was performed. ResultsIn the aspect of intra-operative indicators:the operation time, proximal margin length, distal margin length, and the number of removal lymph node between the 2 groups did not significantly differed with each other (P>0.05); while the bleeding volume and the length of incision in laparoscopy group were significantly less (shorter) than those of laparotomy group (P<0.05). In the aspect of post-operative indicators:the time to first flatus, time to resumed oral intake, time to ambulation, post-operative hospital stay, time of analgesics given, and the total incidence of postoperative complication in laparoscopy group were significantly shorter (less or lower) than those of laparotomy group (P<0.05), the operating cost in laparoscopy group was significantly higher than that of the laparotomy group (P<0.05), but there was no significant difference in total treatment cost, mortality of gastric cancer, and recurrence or metastasis rate between the 2 groups (P>0.05). ConclusionsBoth laparoscopic and laparotomy D2 radical gastrectomy in treatment of advanced gastric cancer can obtain good clinical effect. But compared with laparotomy D2 radical gastrectomy, laparoscopic D2 radical gastrectomy can reduce operative wound, reduce incidence of complications, improve postoperative recovery, and has higher safety.
ObjectiveTo evaluate the efficacy and safety of docetaxel (DOC) combined with oxaliplatin (OXA) regimen in the treatment of advanced gastric cancer. MethodsSixty patients with advanced gastric cancer treated in our hospital from January 2008 to January 2011 were randomly divided into two groups. The treatment group (n=30) was given DOC combined with OXA regimen. Patients in this group were treated with DOC 75 mg/m2, ivgtt, d1; OXA 130 mg/m2, ivgtt, d4; with 21 days as a cycle. The control group (n=30) was given DCF regimen. Patients in the control group were treated with DOC 75 mg/m2, ivgtt, d1; cisplatin 75 mg/m2, ivgtt, d1; calcium folinate 200/m2, ivgtt, 2 h, d1-2; fluorouracil 400 mg/m2, bolus 10 minutes, fluorouracil 600 mg/m2 civ 22 h d1-2; also with 21 days as a cycle. All patients received two cycles of chemotherapy at least. The effective rate (complete remission+partial remission), adverse reactions, median survival time and quality of life were analyzed and compared between the two groups. ResultsThe effective rates in the treatment group and the control group were 60.0% and 46.7% respectively, showing a non-significant difference (P>0.05). The appetite increasing rate (70.0% vs 43.3%), the weight gain rate (60.0% vs 33.3%), and the Karnofsky score improvement rate (63.3% vs 30.0%) of the treatment group were significantly higher than those of the control group (P<0.05). The adverse reactions were fewer in the treatment group, and most of them were between grade Ⅰ and Ⅱ. The median time of disease progression (5.8 months vs 5.6 months) and the median survival period (11.8 months vs 9.2 months) of the treatment group were longer than those in the control group. ConclusionDOC combined with OXA regimen is effective in treating advanced gastric cancer. It can significantly improve the quality of life of the patients, and it has fewer adverse reactions. Meanwhile, the median survival period is prolonged. DOC combined with OXA regimen is worth to be applied in clinic.
ObjectiveTo evaluate the relationship between methylenetetrahydrofolate reductase (MTHFR) gene C677T polymorphism and efficacy of fluorouracil-based chemotherapy in patients with advanced gastric cancer (AGC). MethodsComputer retrieval in China Journal Full-text Database, Chinese Science and Technology Periodical Database, Wanfang database, Chinese Biomedical Literature Database, PubMed, EMbase, Cochrane Library and Web of Science Database (from their establishment to May 28, 2013) was performed to include case-control studies on MTHFR gene C677T polymorphism and sensitivity to fluorouracil-based chemotherapy in patients with advanced gastric cancer. Statistical analysis was done by using RevMan 5.1 software. ResultsSeven case-control studies with 775 patients were included. The meta-analysis showed that among MTHFR C677T genotypes, for TT vs. CC, OR=4.63, 95%CI (1.23, 17.4); and for CC+CT vs. TT, OR=0.21, 95%CI (0.06, 0.78). Subgroup analysis of Asian group showed that for TT vs. CC, OR=32.99, 95%CI (11.40,95.42); and for CC+CT vs. TT, OR=0.04, 95%CI (0.02, 0.10). Sensitivity analysis performed according to different detection methods showed that for TT vs. CC, OR=6.03, 95%CI (1.53, 23.72); and for CC+CT vs.TT, OR=0.17, 95%CI (0.04, 0.68). ConclusionPolymorphism of MTHFR C677T gene may be associated with sensitivity to fluorouracil-based chemotherapy in patients with AGC.
Objective To evaluate the effectiveness and safety of lentinan on immune function in patients with advanced gastric cancer. Methods We searched MEDLINE (1969-2006), EMBASE (1984-2006), OVID (1969-2006), CENTRAL (Cochrane Central Register of Controlled Trials in The Cochrane Library) (Issue 4, 2006), the Chinese Biomedicine Database (1978-2006) and CNKI (1978-2006). We also handsearched relevant journals. Pharmaceutical companies were contacted to identify additional randomized controlled trials. We assessed the identified studies in order to include high quality studies. Results Ten studies (containing 786 patients) met the inclusion criteria. Six trials shown that lentinan+FAM had significant efficacy upon patients with advanced gastric cancer compared with FAM in overall response [Plt;0.01, RR1.70, 95%CI (1.39,2.09)]. In three trials, a significant effect of lentinan+FAM group compared with FAM group in quantity of CD3+ T, T4/T8, NK was found, but lower than FAM group in side- effect of digestive system [RR0.71, 95%CI (0.55,0.91)]. The other trail identified there were fewer side effects in lentinan+FAM group compared with FAM group, though did not discribe the overall response. In case the significant heterogeneity, meta-analysis could not be used for the other three trails included, since the components of chemotherapeutic agents (ATP+Co-A+Vc; DDP+ Epirubicin+5FU; 5FU+CF+VP16) were not the same. In the three trials, overall response was statistically significant better in the lentinan group than in the control group, and lentinan group could significantly increase the quantity of CD3+ T, T4/T8, NK compared with control group. Conclusions The present meta-analysis suggested that addition of lentinan to standard chemotherapy provided a significant advantage over chemotherapy alone in terms of efficacy for patients with advanced gastric cancer. However, most of trials included in the review were of low quality, therefore, it is of necessity to conduct multi-center randomized-controlled trials of high quality.
Objective To investigate the feasibility and safety of laparoscopic-assisted gastrectomy for distant gastric cancer. Methods All 18 patients with distant gastric cancer receiving laparoscopic-assisted gastrectomy were analyzed. Results Laparoscopic-assisted distal gastrectomy was performed successfully in all patients. The mean operation time was (291.33±19.61) min. The mean blood loss was (151.32±71.78) ml. The mean numbers of harvested lymph node were 14.57±3.11. The mean time of gastrointestinal function recovery was (3.46±0.93) d, the mean out of bed activity time was (1.75±0.45) d. All patients were followed up for 1-24 months, mean 11 months. No local recurrence, trocar implant or distant metastasis happened. Conclusion Laparoscopic-assisted gastrectomy is a feasible and safe surgical procedure combined with minimal trauma and fast recovery.