不同化疗方案(PCF vs OLF)治疗晚期胃癌的疗效及安全性评价

The evaluation of efficacy and safety of different combined chemotherapy regimen(PLF vs. OLF) for patients with late-stage gastric carcinoma

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135mg／m^2，第1天；DDP15mg/m^2，第1～5天；5-FU500mg／m^2，第1～5天；每21d重复），或OLF方案（草酸铂130mg/m^2，第1天；LV200mg／m^2，第1～5天；5-FU750mg／m^2．第1～5天；每21d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 purpose： Chemotherapy could improve quality of life and prolong the survival of patients with late-stage gastric carcinoma. No ＂golden standard＂ regimen is to set up nowadays, although there are numerous chemotherapy regimens available. Sixty-one patients with late-stage gastric cancer received either paclitaxel, cisplatin and fluorouracil （PCF） chemotherapy, or oxaliplatin and LV/fluorouracil （OLF） chemotherapy in our hospital. Therefore, the efficacy, adverse reaction, and prognostic factors of two regimens were explored. Methods： Sixty-one patients were divided into two groups. PCF group received 3 to 6 cycles of PCF regimen（ paclitaxel 135 mg/m^2 d 1, cisplatin 15mg/m^2 d 1-5, fluorouracil 500 mg/m^2 d 1-5, once every 21 days）, and OLF group received regimen（ oxaliplatin 130 mg/m^2 d 1, LV 200 mg/m^2 d 1-5, fluorouracil 750 mg/m^2 d 1-5, once every 21 days）, respectively. The follow-up was carried on until all of the patient were deceased. Results： The response rate were 51.6% （16/31） in PCF group and 33.3% （10/30） in OLF group, respectively. There was no significant difference between immediate responses of two groups（ P = 0. 209）. The median time for tumor to progression（TTP） in PCF group and OLF group were both 8 months（ P = 0.414）, and the overall survival（OS） of the PCF group was 14 months, which was slightly longer than the latter（ 13 months, P =0. 300）. The incidence rate of leukocytopenia in PCF group was 80% （ 22/31）, compared to that in OLF group（43, 3%, P = 0. 033）, while the incidence rate of peripheral neuritis of OLF group is statistically higher than that of PCF group（ P 〈 0.001）. Univariate survival analysis showed that female, the patients with IV stage or poor short-term response were negative prognostic factors. Multivariate survival analysis showed that the short-term effect was the only independent prognostic factor for TTP and OS of the patients with late-stage gastric carcinoma. Conclusions： PCF and OLF regimens have similar short- and long-term effect and both were well tolerated for the treatment of late-stage gastric carcinoma. And the short-term effect of chemotherapy was the independent prognostic factor for TTP and OS in the patients with late-stage gastric carcinoma.