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背景与目的:化学治疗可提高晚期胃癌患者的生活质量,延长生存期,但胃癌化疗方案众多,目前尚无“金标准”可循。本研究对61例晚期胃癌分别施以紫杉醇+顺铂(DDP)+氟尿嘧啶(5-FU)(PCF)方案或草酸铂+亚叶酸钙(LV)/5-FU(OLF)方案化疗,探讨不同方案的化疗疗效、不良反应及预后的影响因素。方法:61例晚期胃癌患者分两组,分别接受PCF方案(紫杉醇135 mg/m2,第1天;DDP 15 mg/m2,第1~5天;5-FU 500 mg/m2,第1~5天;每21 d重复),或OLF方案(草酸铂130 mg/m2,第1天;LV 200 mg/m2,第1~5天;5-FU 750 mg/m2,第1~5天;每21 d重复)3~6个周期,然后对所有患者进行随访至死亡为止。结果:PCF组有效率为51.6%(16/31),OLF组有效率为33.3%(10/30),两组近期疗效差异无显著性(P=0.209),PCF和OLF组的中位肿瘤进展时间(TTP)均为8个月(P=0.414),而前者的中位总生存期(OS)14个月,略优于后者(13个月),但差异无显著性(P=0.300);PCF组的白细胞减少发生率达80%(22/31),显著高于OLF组(43.3%,P=0.033),而OLF组的外周神经炎发生率显著高于PCF组(P<0.001)。单因素生存分析提示女性、临床分期Ⅳ期、近期疗效较差者的预后不佳,而多因素生存分析显示,近期疗效是决定晚期胃癌TTP和OS的唯一独立预后因素。结论:PCF和OLF两种方案治疗晚期胃癌,近、远期疗效相近而耐受性较好,而化疗的近期疗效是晚期胃癌患者TTP和OS的独立预后因素。
Background and Objective: Chemotherapy can improve the quality of life and prolong the survival of patients with advanced gastric cancer. However, there are many chemotherapy regimens for gastric cancer, so there is no “gold standard” to follow. In this study, 61 patients with advanced gastric cancer were treated with paclitaxel + cisplatin (DDP) + 5-fluorouracil (PCF) or oxaliplatin + leucovorin (LV) / 5-FU Chemotherapy efficacy, adverse reactions and prognostic factors. Methods: Sixty-one patients with advanced gastric cancer were divided into two groups and received PCF regimen (paclitaxel 135 mg / m2 on day 1; DDP 15 mg / m2 on days 1-5; 5-FU 500 mg / m2; Day; repeated every 21 days) or OLF regimen (oxaliplatin 130 mg / m2 on day 1; LV 200 mg / m2 on days 1 to 5; 5-FU 750 mg / m2 on days 1 to 5; 21 d repeat) 3 ~ 6 cycles, and then all patients were followed up to death. Results: The effective rate was 51.6% (16/31) in PCF group and 33.3% (10/30) in OLF group, there was no significant difference between the two groups (P = 0.209) The median time to progression (TTP) was 8 months (P = 0.414), while the median overall survival (OS) was 14 months slightly better than the latter (13 months), but the difference was not significant (P = 0.300). The incidence of leukopenia in PCF group was 80% (22/31), significantly higher than that in OLF group (43.3%, P = 0.033), while the incidence of peripheral neuritis in OLF group was significantly higher than that in PCF group (P < 0.001). Univariate survival analysis showed that the prognosis of women with stage Ⅳ clinical stage and poor prognosis in the near future was poor. Multivariate survival analysis showed that the short-term curative effect was the only independent prognostic factor for TTP and OS in advanced gastric cancer. CONCLUSION: Both PCF and OLF regimens are effective in the treatment of advanced gastric cancer with similar short-term and long-term efficacy. However, the short-term effect of chemotherapy is an independent prognostic factor for TTP and OS in patients with advanced gastric cancer.