卡培他滨联合奥沙利铂术前新辅助化疗治疗中晚期胃癌的疗效分析

Clinical Efficacy of Capecitabine and Oxaliplatin in Preoperative Neoadjuvant Chemotherapy for Middle-advanced Gastric Cancer

目的：观察中晚期胃癌术前应用卡培他滨联合奥沙利铂进行新辅助化疗的疗效及不良反应。方法将90例患者随机分成A实验组、B对照组，每组45例。A实验组：第1～14天给予卡培他滨2500 mg/m2口服，分早晚各1次；同时在第1天时给予奥沙利铂溶于5％葡萄糖注射液500 ml，外周静脉滴注2 h。每3周重复1次，连续使用2个疗程。化疗结束后术前复查评估化疗效果。在新辅助化疗结束后2～4周行胃癌根治术治疗。 B对照组：患者在确诊后2周内进行胃癌根治术治疗。2组均行D2式淋巴结清扫术。结果 A实验组45例患者中完全缓解（CR）3例（6．7％），部分缓解（PR）25例（55．6％），稳定（SD）14例（31．1％），进展（PD）3例（6．7％）；化疗不良反应主要是腹泻、手足综合征、口腔黏膜溃疡和外周神经炎。 A实验组术后复发率为13．3％（6/45），生存率44．4％（20/45），中位生存期为26．7个月；B对照组术后复发率为33．3％（15/45），生存率为17．7％（8/45），中位生存期为15．9个月。2组在复发率和生存率方面差异均有统计学意义（χ2＝5．031，P＝0．025；χ2＝7．465，P＝0．006）。结论中晚期胃癌术前应用卡培他滨联合奥沙利铂进行新辅助化疗，可以降低中晚期胃癌患者术后复发率，改善患者术后生存率。

Objective To observe the curative effect and adverse reactions of capecitabine combined with oxaliplatin in the preoperative neoadjuvant chemotherapy for middle-advanced gastric cancer .Methods 90 patients were randomly divided in-to the experimental group A and the control group B ,45 cases in each .Group A was given capecitabine 2 500 mg/m2 twice a day for 14 days,and oxaliplatin solvated in 5%glucose injection 500 ml by 2 h peripheral intravenous drip every 3 weeks for 2 cour-ses.Curative effect was evaluated after chemotherapy .Radical gastrectomy was performed 2-4 weeks after the neoadjuvant chemo-therapy Group B received radical gastrectomy 2 weeks after the diagnosis .The 2 groups all received D2 lymphadenectomy .Results In the group A,CR rate was 6.7%、PR rate was 55.6%、SD rate was 31.1%、PD rate was 6.7%.The adverse reactions were mainly diarrhea , extremities syndrome , oral mucosa ulcer and peripheral neuritis .The postoperative recurrence rates of the 2 groups were 13.3%(6/45) and 33.3%(15/45).The survival rate of Group A was 44.4%(20/45) and the median survival was 26.7 months;The survival rate Group A was 17.7%(8/45) and the median survival was 15.9 months;there were statistical differences (respectively χ2 =5.031,P=0.025;χ2 =7.465,P=0.006).Conclusion Capecitabine combined with oxaliplatin in preoperative neoadjuvant chemotherapy for middle-advanced gastric cancer can reduce the recurrence and improve the survival rate.