吉西他滨联合奥沙利铂或氟尿嘧啶治疗晚期胰腺癌临床观察

Comparative study of gemcitabine plus oxaliplatin and gemcitabine plus fluorouracil for treatment of advanced pancreatic cancer.

目的观察吉西他滨联合奥沙利铂（GEMOX方案）与吉西他滨联合氟尿嘧啶（GF方案）治疗晚期胰腺癌的近期疗效和不良反应。方法经病理组织学或细胞学证实的40例胰腺癌患者，随机对照分为GEMOX组和GF组，各20例。可评价疗效分别为15例和14例。GEMOX组给予吉西他滨1000mg／m。加生理盐水100ml，静脉滴注30min，第1，8，15d；奥沙利铂50mg／m^2，静脉滴注，第1，8，15d。GF组给予吉西他滨1000mg／m^2加生理盐水100ml，静脉滴注30min，第1，8，15d，氟尿嘧啶500mg／m^2加5％葡萄糖液（GS）500ml，静脉滴注6h以上，第1～5d。结果两组患者性别、肿瘤病理类型及TNM分期具可比性。GEMOX组部分缓解（PR）2例，微效（MR）3例，稳定（D）6例，进展（PD）4例，治疗有效率达33．3％，中位生存期8．7个月，临床受益率（CBR）50．O％，肿瘤标志物CA19—9下降〉50%占47．1％。GF组PR2例，MR3例，SD5例，PD4例，治疗有效率达35．7％，中位生存期10．1个月，CBR38．9%，CA19—9下降〉50％占38．9％。经统计学比较，两组CBR差异有显著性（P〈0．05）。主要不良反应为白细胞减少和血小板减少。结论吉西他滨联合奥沙利铂或联合氟尿嘧啶的治疗有效率、CBR较高，中位生存期较长，不良反应小。GEMOX的CBR较GF更高。

Objective To compare the efficacy and toxicity of gemeitabine plus oxaliplatin and gemeitabine plus fluorouraeil for the treatment of advanced pancreatic cancer. Methods Twenty-nine patients with advanced pancreatic cancer were randomly divided into group GEMOX （n = 15） and group GF （n = 14）. All patients were treated with gemeitabine at a dose of 1 000 mg/m^2（diluted in 100 ml NS over 30 minutes） once a week for 3 consecutive weeks every 4 weeks. Group GEMOX was followed by oxaliplatin 50 mg once a week for 3 consecutive weeks every 4 weeks. Group GF was followed by 5-FU 500 mg/m^2 （diluted in 5% GS 500 ml, iv, over 6 h）, on day 1 - 5. Results In group GEMOX, 5 patients （33. 3%） experienced PR and MR; the median survival time was 8. 7 months, the clinieal beneficial Rate （CBR） was 50. 0%, and CA19-9 decreased by over 50% in 8 patients（47. 1%）. In group GF, 5 patients（35. 7%） experienced PR and MR; the median survival time was 10. 1 months, CBR was 38.9%, and CA19-9 decreased by over 50% in 7 patients. There was a significant difference in CBR between the two groups （P 〈 0. 05）. The main side effect included leukopenia and thrombocytopenia. Conclusions GEMOX or GF is a feasible and well-tolerated scheme in treating advanced pancreatic cancer in terms of good therapeutic efficacy, few side effect, long median survival and high CBR, especially in the GEMOX scheme.