title: [Effects of XELOX regimen as neoadjuvant chemotherapy on radical resection rate and prognosis in patients with advanced gastric cancer].
abstract: 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: neoadjuvant chemotherapy group (40 cases) and surgery alone group (45 cases). In the neoadjuvant chemotherapy group, patients received oral administration of Xeloda 1000 mg/m(2) twice a day on days 1-14 and intravenous infusion of oxaliplatin 130 mg/m(2) on day 1 (XELOX regimen). The regimen was repeated every 21 days. In the surgery alone group, patients directly received radical resection of gastric cancer. The R0 resection rate, overall survival and disease free survival (DFS) were observed in all cases. The cycles and apoptosis rate of the gastric cancer cells were detected by flow cytometry. The expression of proliferating cell nuclear antigen (PCNA), p21, p53 and survivin was detected by Western blot.
  
  
  RESULTS
  In the neoadjuvant chemotherapy group, the total effective rate was 32.5% (13/40), and the tumor control rate was 90% (36/40), with few side effects. Compared with the surgery alone group, R0 resection rate was significantly higher in the neoadjuvant chemotherapy group (P < 0.05). The survival analysis indicated that both the overall survival and DFS were longer in the neoadjuvant chemotherapy group in comparison with those in the surgery alone group, but no significant differences were found (P > 0.05). In the neoadjuvant chemotherapy group, both the apoptosis rate and the ratio of cells in stage G0 and G1 were significantly higher than those in the surgery alone group (P < 0.05). The expression of PCNA and survivin was lower in the neoadjuvant chemotherapy 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 can effectively improve the R0 resection rate and prolong the survival time of the patients. Its mechanism is probably that the neoadjuvant chemotherapy can markedly enhance apoptosis in gastric cancer cells and inhibit their proliferation.
authors.affiliation: Department of General Surgery, the Fourth Affiliated Hospital, Hebei Medical University, Shijiazhuang 050011, China.
authors.forename: Qun
authors.initials: Q
authors.lastname: Zhao
authors.affiliation: Department of General Surgery, the Fourth Affiliated Hospital, Hebei Medical University, Shijiazhuang 050011, China. Email: li_yong_hbth@126.com.
authors.forename: Yong
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of General Surgery, the Fourth Affiliated Hospital, Hebei Medical University, Shijiazhuang 050011, China.
authors.forename: Bi-bo
authors.initials: BB
authors.lastname: Tan
authors.affiliation: Department of General Surgery, the Fourth Affiliated Hospital, Hebei Medical University, Shijiazhuang 050011, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Tian
authors.affiliation: Department of General Surgery, the Fourth Affiliated Hospital, Hebei Medical University, Shijiazhuang 050011, China.
authors.forename: Zhi-kai
authors.initials: ZK
authors.lastname: Jiao
authors.affiliation: Department of General Surgery, the Fourth Affiliated Hospital, Hebei Medical University, Shijiazhuang 050011, China.
authors.forename: Xue-feng
authors.initials: XF
authors.lastname: Zhao
authors.affiliation: Department of General Surgery, the Fourth Affiliated Hospital, Hebei Medical University, Shijiazhuang 050011, China.
authors.forename: Zhi-dong
authors.initials: ZD
authors.lastname: Zhang
authors.affiliation: Department of General Surgery, the Fourth Affiliated Hospital, Hebei Medical University, Shijiazhuang 050011, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Wang
authors.affiliation: Department of General Surgery, the Fourth Affiliated Hospital, Hebei Medical University, Shijiazhuang 050011, China.
authors.forename: Pei-gang
authors.initials: PG
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017209:Apoptosis / Q000187:drug effects; D000069287:Capecitabine; D002453:Cell Cycle / Q000187:drug effects; D017024:Chemotherapy, Adjuvant; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D051034:Inhibitor of Apoptosis Proteins / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010071:Oxaloacetates; D018809:Proliferating Cell Nuclear Antigen / Q000378:metabolism; D016283:Proto-Oncogene Proteins p21(ras) / Q000378:metabolism; D012074:Remission Induction; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D015996:Survival Rate; D000077022:Survivin; D016159:Tumor Suppressor Protein p53 / Q000378:metabolism
chemical_list: C107489:BIRC5 protein, human; D051034:Inhibitor of Apoptosis Proteins; D010071:Oxaloacetates; D018809:Proliferating Cell Nuclear Antigen; D000077022:Survivin; C495901:TP53 protein, human; D016159:Tumor Suppressor Protein p53; D003841:Deoxycytidine; D000069287:Capecitabine; D016283:Proto-Oncogene Proteins p21(ras); D005472:Fluorouracil