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Objective: Gastric cancer is one of the highest cancer incidence and mortality rates of the tumors. Recent years due to gastroesophageal junction cancer incidence gradually increased, gastroesophageal junction cancer particularity more attention. Previous researchers to be more mixed in gastric or esophageal cancer, while a large literature because of its specific anatomical location, gastroesophageal junction cancer in epidemiological and etiological, clinical pathology, treatment and prognosis of esophageal and gastric cancers were associated with non- to do the same, in terms of research or clinical aspects of the tumor should be treated as an independent. According to national statistics, gastric cancer patients after an average 5-year survival was 37% -50%, while the gastroesophageal junction cancer was only 20.2% -35.3%, the prognosis is worse than the stomach. Although in recent years has been carried out in one, two control work to make the detection rate of early gastric cancer has increased, but in patients with advanced inoperable still accounts for more than half of first-line adjuvant chemotherapy and chemotherapy can prolong survival time and improve quality of life, This has become a consensus. But cancer is currently no standard adjuvant and first-line chemotherapy, gastroesophageal junction cancer treatment guidelines have been following gastric cancer, both no \Cisplatin and fluorouracil is commonly used cancer chemotherapy, and REAL-2 and other clinical trials with oxaliplatin has a good effect, so in recent years, with oxaliplatin-based FOLFOX4 regimen gradually applied in the treatment of patients with gastric cancer in the past. This study retrospectively analyzed with FOLFOX4 (oxaliplatin fluorouracil leucovorin) with FLP program (Cisplatin Fluorouracil Leucovorin) in gastroesophageal junction cancer and distal gastric cancer and late postoperative adjuvant chemotherapy in first-line chemotherapy for Help gastroesophageal junction cancer and distal gastric cancer patients choose chemotherapy better make a useful exploration. Method: 1 FOLFOX4 with FLP program in gastroesophageal junction and distal gastric cancer adjuvant chemotherapy in clinical efficacy. Fourth Hospital of Hebei Medical University Oncology March 1, 2007 - October 31, 2009 admitted pathological diagnosis confirmed gastroesophageal junction cancer and distal gastric cancer patients with 553 cases, the establishment of clinical information databases. Use of adjuvant chemotherapy after curative resection in patients with a total of 362 cases, selected chemotherapy with FOLFOX4 and FLP program to those 267 cases for the study, in which patients with gastroesophageal junction cancer, 123 cases, 144 cases of distal gastric cancer patients. Follow-up observation of the main indicators of disease-free survival (Disease-Free Survival, DFS), overall survival (Overall survival, OS) and Hematology / non-hematologic adverse reactions, and gender (male / female), age (≤ 45 years / 46 years -65 years /> 65 years), histological type (adenocarcinoma / mucinous adenocarcinoma / signet ring cell carcinoma / other), stage (I stage / II stage / IIIA period / IIIB period / IV stage), lymph node cut the number of (≤ 15 枚 / gt; 15 pieces) and other layered, stratified on the two groups to compare two programs at the gastroesophageal junction cancer and distal gastric cancer in the efficacy and adverse reactions. 2 FOLFOX4 with FLP program in advanced gastroesophageal junction and distal gastric cancer clinical efficacy of first-line chemotherapy in comparison. Receiving first-line chemotherapy database of 299 patients with advanced cases, chemotherapy is selected and the FLP program FOLFOX4 regimen for the study were 164 cases (including 114 cases of previously untreated patients with advanced disease, 50 patients with recurrence), which gastroesophageal junction cancer 80 cases, 84 cases of distal gastric cancer. Follow-up observation of the main indicators of progression-free survival (progression-Free Survival, PFS) and OS, according to the overall cases, initial treatment in advanced cases and postoperative recurrence group statistics. 3 information through outpatient follow-up, re-hospitalization and telephone follow-up by way of follow-up finish at the time of death or last follow-up. The study followed deadline for December 31, 2010. 4 using SPSS13.0 software for statistical analysis, balance test using the chi-square test, survival probability stratified analysis stratified chi-square test, DFS, PFS and OS calculated using the product-limit method (Kaplan-Meier), with P lt ; 0.05 as statistically significant difference. Results: 1 FOLFOX4 with FLP program in gastroesophageal junction cancer and distal gastric cancer adjuvant chemotherapy in clinical comparison: 1.1 FOLFOX4 with FLP program in gastroesophageal junction cancer, postoperative adjuvant chemotherapy in clinical efficacy. FOLFOX4 group and the FLP group, the median DFS was 35.9 months and 16.8 months (P = 0.008), median OS was 41.3 months and 25.6 months (P = 0.013); stratified analysis showed that for men, 46 -65 years old, adenocarcinoma, II Phase, IIIA phase patients, FOLFOX4 program a higher probability of survival, with a significant survival advantage (P lt; 0.05), OR values ??and 95% confidence intervals were 2.522 (95% CI: 1.100-5.780; P = 0.041), 3.095 (95% CI: 1.177-8.137; P = 0.018), 2.291 (95% CI: 1.017-5.158; P = 0.048), 6.667 (95% CI: 1.244-35.714; P = 0.030), 2.969 (95% CI: 1.033-8.532; P = 0.040). FOLFOX4 and FLP programs were well tolerated, hematologic adverse reactions was no significant difference, FOLFOX4 program non-hematologic adverse reactions mainly peripheral neurotoxicity, FLP program were gastrointestinal reactions. 1.2 FOLFOX4 with FLP program on the remote postoperative adjuvant chemotherapy in gastric cancer clinical comparison of: FOLFOX4 regimen group and the FLP program group, the median DFS was 35.8 months and 31.8 months (P = 0.925), median OS was was 46.6 months and 43.5 months (P = 0.720). Stratified analysis for gender, age, histological type, clinical stage and lymph node stratification factors such as the number of cut, FOLFOX4 and FLP program had no statistically significant difference in survival probability. FOLFOX4 and FLP program hematologic adverse reactions were no significant differences could be tolerated, non-hematologic adverse reactions were focused on the performance in the peripheral neurotoxicity and gastrointestinal reactions. 2 FOLFOX4 with FLP program in advanced gastroesophageal junction and distal gastric cancer clinical efficacy of first-line chemotherapy in comparison: 2.1 FOLFOX4 with FLP program in advanced gastroesophageal junction cancer clinical efficacy of first-line chemotherapy in comparison. Overall cases, FOLFOX4 regimen group and FLP program group, the median PFS was 7.8 months and 6.4 months (P = 0.429), median OS was 13.7 months and 13.4 months (P = 0.846); untreated advanced cases, the median PFS was 8.7 months and 6.0 months (P = 0.960), median OS was 14.4 months and 13.7 months (P = 0.396); postoperative recurrence, the median PFS was 5.6 months and 6.4 months (P = 0.184), median OS was 10.6 months and 11.4 months (P = 0.471). 2.2 FOLFOX4 program with FLP-line chemotherapy in patients with advanced distal gastric cancer in clinical efficacy. Overall cases, FOLFOX4 regimen group and FLP program group, the median PFS was 7.6 months and 5.6 months (P = 0.556), median OS was 14.9 months and 9.6 months (P = 0.421); untreated advanced cases, the median PFS was 7.6 months and 7.0 months (P = 0.406), median OS was 14.2 months and 17.6 months (P = 0.305). Postoperative recurrence, the median PFS was 6.2 months and 3.3 months (P = 0.021), median OS was 16.3 months and 6.9 months (P = 0.022). Conclusion: a retrospective study shows that in the gastroesophageal junction cancer adjuvant chemotherapy, compared with the FLP program, FOLFOX4 programs prolong the DFS and OS, the male ,46-65 years old, adenocarcinoma, II or IIIA patients, FOLFOX4 program can significantly improve the probability of survival. 2 In the distal gastric cancer adjuvant chemotherapy, FOLFOX4 programs and FLP regimens rather, DFS, OS, and the probability of survival was no significant difference. 3 in advanced gastroesophageal junction cancer, first-line chemotherapy, FOLFOX4 programs and FLP regimens rather, PFS and OS were no significant differences. 4-line chemotherapy in patients with advanced gastric cancer in a remote, FOLFOX4 programs and FLP regimens rather, in patients with FOLFOX4 recurrence than the FLP program prolong PFS and OS.
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