Abstract: Objective  To investigate the effects of calcium levofolinate and 5-fluorouracil combined with epirubicin on stress response and vascular endothelial growth factor (VEGF) level in patients with gastric cancer. Methods  A total of 160 patients with gastric cancer treated in Huxi Hospital Affiliated to Jining Medical College from April 2016 to March 2018 were selected as research objects. All the patients were divided into two groups according to the random number table method and each group consisted of 80 cases. The control group was treated with epirubicin, while the study group was treated with calcium levofolinate and 5-fluorouracil combined with epirubicin. The clinical efficacy and adverse reactions of the two groups were observed and compared. The levels of VEGF and quality of life were compared before and after the treatment. The stress response indexes such as cortisol (Cor), norepinephrine (NE) and total antioxidant capacity (TAC) were detected, and the stress levels of the two groups were compared. Results  The total effective rate of the study group was 67.5% (54/80), which was significantly better than that of the control group ［45.0% (36/80)］, and the difference was statistically significant (χ²=8.229, P=0.004).  The quality of life of the two groups after the treatment was significantly higher than that before the treatment, and the quality of life scores of the study group were significantly higher than those of the control group (all P<0.001).  After the treatment, the levels of Cor, NE and TAC of the study group were (239.27±19.63) μg/L, (258.46±18.31) ng/L, (11.01±0.77) KIU/L, which were significantly lower than those of the control group ［(286.35±20.63) μg/L, (294.18±21.95) ng/L, (12.73±1.58) KIU/L］, and the differences were statistically significant (t=10.003, P<0.001; t=9.476, P<0.001; t=6.984, P<0.001). After the treatment, the VEGF levels of the two groups were lower than those before the treatment, and the VEGF level of the study group was significantly lower than that of the control group ［(39.4±0.9) pg/ml vs. (42.3±1.1) pg/ml, t=18.251, P<0.001］. The total incidences of adverse reactions in the control group and the study group were 82.5% (66/80) and 48.8% (39/80), respectively. The incidence of adverse reactions in the control group was significantly higher than that in the study group, and the difference was statistically significant (χ²=20.197, P<0.001). Conclusion  Calcium levofolinate and 5-fluorouracil combined with epirubicin has a good clinical effect in treating patients with gastric cancer. It can not only improve the level of VEGF in the serum of patients, but also can improve the quality of life of patients, reduce the incidence of adverse reactions and body stress response. It has broad application prospects and is worthy of further promotion and application in clinic.

Key words: Stomach neoplasms, Vascular endothelial growth factors, Stress response, Epirubicin, Calcium levofolate