紫杉醇联合卡铂单周化疗方案与奥沙利铂联合卡培他滨方案对Ⅲ期胃癌患者的疗效及安全性比较

Comparison of efficacy and safety of paclitaxel combined with carboplatin single-week chemotherapy regimen and oxaliplatin combined with capecitabine regimen treating for stageⅢgastric cancer

目的探讨紫杉醇联合卡铂单周化疗(TP周疗)方案与奥沙利铂联合卡培他滨(XELOX)方案对Ⅲ期胃癌患者的疗效及安全性。方法选取2017年1月至2018年12月河北北方学院附属第一医院收治的Ⅲ期胃癌患者100例,应用随机数字表法分为TP周疗组和XELOX组,各50例,TP周疗组应用紫杉醇联合卡铂单周治疗方案,XELOX组应用奥沙利铂联合卡培他滨治疗方案,2组患者均在完成3个疗程新辅助化疗后休息4周,行腹腔镜下D2根除手术。比较2组患者新辅助化疗后的近期疗效、R0切除率、临床病理分期和治疗前后血清肿瘤标志物水平以及安全性。结果完成3个疗程新辅助化疗后,XELOX组患者均未达到完全缓解,TP周疗组近期疗效和临床病理分期均优于XELOX组,总有效率和疾病控制率均高于XELOX组[42.0%(21/50)比20.0%(10/50)、94.0%(47/50)比78.0%(39/50)],R0切除率高于XELOX组[78.0%(39/50)比54.0%(27/50)](均P <0.05)。2组患者的血清CA125、CA199、癌胚抗原水平均低于治疗前,且TP周疗组显著低于XELOX组[(32±12) k U/L比(44±15) k U/L、(38±18) k U/L比(60±22) k U/L、(6.1±2.4)μg/L比(7.8±2.1)μg/L](均P <0.05)。TP周疗组恶心、呕吐的发生率和严重程度低于XELOX组(P <0.05),但2组患者血液学毒性、肝肾毒性和神经毒性比较差异均无统计学意义(均P>0.05)。结论与XELOX方案相比,TP周疗方案对Ⅲ期胃癌患者的近期疗效和R0根治性切除率均有所提高,而因化疗引起的胃肠不良反应发生率和严重程度降低。

Objective To compare the efficacy and safety of paclitaxel combined with carboplatin single-week chemotherapy regimen(TP weekly therapy regimen)and oxaliplatin combined with capecitabine regimen(XELOX regimen)treating for stageⅢgastric cancer.Methods From January 2017 to December 2018,100 patients with stageⅢgastric cancer admitted to the First Affiliated Hospital of Hebei North University were collected.They were randomly divided into TP weekly group and XELOX group,with 50 cases in each group.TP weekly group was treated with paclitaxel and carboplatin dose-dense weekly regimen;XELOX group was treated with capecitabine combined with oxaliplatin regimen.All patients had the laparoscopic D2 radical resection.The short-term efficacy after neoadjuvant chemotherapy,tumor node metastasis(TNM)stage,R0 resection rate,serum carbohydrate antigen 125(CA125),CA199 and carcinoembryonic antigen(CEA)levels and safety were evaluated and compared between the two groups.Results After completing 3 courses of neoadjuvant chemotherapy,none of the patients in the XELOX group achieved complete remission;the short-term efficacy and clinical pathological staging of the TP weekly group were superior to the XELOX group.The total curative effect rate[42.0%(21/50)vs20.0%(10/50)],disease control rate[94.0%(47/50)vs 78.0%(39/50)]and R0 resection rate[78.0%(39/50)vs 54.0%(27/50)]of patients in TP weekly group were all higher than those in XELOX group(all P<0.05);the serum CA125,CA199 and CEA levels[(32±12)k U/L vs(44±15)k U/L,(38±18)k U/L vs(60±22)k U/L,(6.1±2.4)μg/L vs(7.8±2.1)μg/L]were lower than those in XELOX group(all P<0.05).The incidence of nausea and vomiting in TP weekly group was lower than that in XELOX group(P<0.05);there were no differences of hematology toxicity,toxicity of liver and kidney and neurotoxicity between TP weekly group and XELOX group(all P>0.05).Conclusion Compared with the XELOX regimen,the TP weekly regimen can improve the short-term efficacy and R0 radical resection rate of patients with stageⅢgastric cancer;the incidence and severity of gastrointestinal adverse reactions due to chemotherapy are reduce.