局部进展期胃癌术前化疗与术前放化疗的对比研究

doi:10.19401/j.cnki.1007-3639.2018.10.007

中国癌症杂志 ›› 2018, Vol. 28 ›› Issue (10): 762-768.doi: 10.19401/j.cnki.1007-3639.2018.10.007

局部进展期胃癌术前化疗与术前放化疗的对比研究

刘晓文¹，龙子雯¹，蔡　宏¹，章　真²，王亚农¹

1. 复旦大学附属肿瘤医院胃外科，复旦大学上海医学院肿瘤学系，上海 200032 ；
2. 复旦大学附属肿瘤医院放疗科，复旦大学上海医学院肿瘤学系，上海 200032

出版日期:2018-10-30 发布日期:2018-11-12
通信作者: 王亚农 E-mail: wangyn1111@hotmail.com

Comparison of preoperative chemotherapy and preoperative radiochemotherapy in patients with locally advanced gastric cancer

LIU Xiaowen¹, LONG Ziwen¹, CAI Hong¹, ZHANG Zhen², WANG Yanong¹

1. Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; 2. Department of Radiotherapy, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China

Published:2018-10-30 Online:2018-11-12
Contact: WANG Yanong E-mail: wangyn1111@hotmail.com

摘要/Abstract

摘要： 背景与目的：术前化疗和术前放化疗都是胃癌治疗指南推荐的针对局部进展期胃癌患者的治疗方法。然而，由于缺乏对比性的研究证据，两者的优劣性不详。本研究将对比术前放化疗与术前化疗在临床疗效及毒性反应之间的差异。方法：2007年6月—2012年10月期间，30例局部进展期胃癌患者入组一项术前化疗的Ⅱ期临床试验，采用EOF（表柔比星+奥沙利铂+氟尿嘧啶）方案进行3~4个周期的术前化疗，对于能手术的患者予以手术，术后给于2~3个周期的EOF方案化疗。2012年4月—2014年8月，40例局部晚期胃癌患者入组一项术前放化疗的Ⅱ期临床试验，患者接受1个周期的SOX［替吉奥（S-1）+奥沙利铂］方案化疗，继续行同步放化疗，再进行1个周期的SOX方案化疗，对于能手术的患者予以手术，术后给于4个周期的SOX方案化疗。比较两项临床试验患者的临床病理特点、术前治疗的效果、R0手术切除率、预后及不良反应。结果：术前化疗临床试验定义为化疗组，有30例胃癌患者入组，且完成了所有的术前化疗，都可评估。术前放化疗临床试验定义为放化疗组，有40例胃癌患者入组，其中36例（90%）患者可评估。两组间的基线参数，如性别、年龄、美国东部肿瘤协作组（Eastern Cooperative Oncology Group，ECOG）评分、临床T分期、临床N分期及肿瘤部位，差异无统计学意义。化疗组的临床有效率（CR+PR）为30%（9/30），放化疗组的临床有效率（CR+PR）为41.7%，两者间的差异无统计学意义（P>0.05）。化疗组与放化疗组间的R0手术切除率差异无统计学意义（46.7% vs 66.7%）。放化疗组的病理有效率高于化疗组，且差异有统计学意义（50.0% vs 23.3%）。术前放化疗组的毒性反应较化疗组明显。放化疗组的3年总生存率为41%，高于化疗组的20% （P=0.009）。结论：放化疗组的病理有效率及3年总生存率高于化疗组。急性毒性反应也较化疗组明显，但无严重的毒性反应。

关键词: 局部晚期胃癌, 术前化疗, 术前放化疗, 预后

Abstract: Background and purpose: Although both preoperative chemotherapy and preoperative radiochemotherapy are recommended by Gastric Cancer Treatment Guidelines for patients with locally advanced gastric cancer, priority treatment is still unclear. The aim of this study was to compare preoperative chemotherapy with preoperative radiochemotherapy. Methods: From Jun. 2007 to Oct. 2012, thirty patients diagnosed as having locally advanced gastric cancer were included in a phase Ⅱ clinical trial, and the patients were defined as chemotherapy group. All these patients received the 3-4 cycles of preoperative chemotherapy, and the regime was EOF (epirubicin, oxaliplatin and 5-FU). After surgery, additional 2-3 cycles of chemotherapy were given. From Apr. 2012 to Aug. 2014, 40 patients with locally advanced gastric cancer were included in a phase Ⅱ clinical trial, and the patients were defined as radiochemotherapy group. Patients received one cycle of SOX (S-1 and oxaliplatin) followed by concurrent radiation and S-1 chemotherapy, then underwent another cycle of SOX. Following surgery, additional four cycles of chemotherapy were administered. Finally, the efficacy and toxicity between preoperative chemotherapy and radiochemotherapy were compared. Results: Thirty patients completed the planned treatment of preoperative chemotherapy. Forty patients were included in the group of preoperative radiochemotherapy, and thirty-six patients were evaluable. There was no significant difference in baseline characteristics between chemotherapy and radiochemotherapy groups. There was no significant difference in clinical response rate or radical gastrectomy between two groups (41.7% vs 30.0%, 46.7% vs 66.7%, respectively). The pathological response rate in radiochemotherapy group was significantly higher than that of chemotherapy (50.0% vs 23.3%). Radiochemotherapy group had a higher rate of 3-year overall survival than chemotherapy group (41% vs 20%, P=0.009). Conclusion: The pathological response rate and 3-year overall survival rate of preoperative radiochemotherapy group were higher than those in preoperative chemotherapy group; the therapy-induced toxicity was more common in preoperative radiochemotherapy group than that in preoperative chemotherapy group.

Key words: Locally advanced gastric cancer, Preoperative chemotherapy, Preoperative radiochemotherapy, Prognosis

刘晓文,龙子雯,蔡　宏,等. 局部进展期胃癌术前化疗与术前放化疗的对比研究[J]. 中国癌症杂志, 2018, 28(10): 762-768.

LIU Xiaowen, LONG Ziwen, CAI Hong, et al. Comparison of preoperative chemotherapy and preoperative radiochemotherapy in patients with locally advanced gastric cancer[J]. China Oncology, 2018, 28(10): 762-768.

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局部进展期胃癌术前化疗与术前放化疗的对比研究

Comparison of preoperative chemotherapy and preoperative radiochemotherapy in patients with locally advanced gastric cancer

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