结直肠癌术后行5-FU／LV和FOLFOX4方案化疗的疗效及安全性

Analysis of efficacy and safety of the postoperative adjuvant chemotherapy with 5-FU/LV or FOLFOX4 regimen for patients with colorectal carcinoma （ Dukes stage B or C）

目的分析Dukes B、C期结直肠癌患者根治性手术后，给予5-氟尿嘧啶（5-Fu）持续静脉给药联合中剂量甲酰四氢叶酸（LV，5-FU／LV方案）或奥沙利铂（L—OHP）联合5-FU／LV（FOLFOX4方案）辅助化疗的疗效及安全性。方法对1999年1月至2003年12月188例Dukes B、C期结直肠癌根治术后患者的临床资料进行回顾性分析，Dukes B期、C期均分为单纯手术组、术后5-FU／LV化疗组和FOLFOX4化疗组。结果Dukes B期：5年生存率分别为单纯手术组67％，术后5-FU／LV辅助化疗组90％，术后FOLFOX4辅助化疗组73％；Dukes C期：3年生存率分别为单纯手术组50％．术后5-FU／LV辅助化疗组76％，术后FOLFOX4辅助化疗组86％。两种辅助化疗方案主要的毒性反应为食欲不振、恶心呕吐、脱发和局部色素沉着，毒性反应多为1～2级，3级毒性反应的发生率分别为9．9％（5-FU／LV）和13．5％（FOLFOX4），未出现4级反应。结论 DukesB期结直肠癌根治术后行5-FU／LV辅助化疗方案能够提高患者5年生存率，加用奥沙利铂后并不提高5年生存率。而对于Dukes C期患者，行FOLFOX4辅助化疗3年生存率可能优于5-FU／LV方案。两种辅助方案3级毒性反应发生率低，安全性好。

Objective To evaluated the efficacy and safety of postoperative adjuvant chemotherapy with 5-FU/LV or FOLFOX4 regimen for patients with colorectal carcinoma （Dukes stage B or C ）. Methods In this study 188 patients with Dukes B or Dukes C stage colorectal carcinoma undergoing curative resection alone, or received 5-FU/LV or FOLFOX4 regimen postoperative adjuvant chemotherapy were reviewed. The end point was 3 or 5-year survival rate. The side effects were recorded. Results The 5-year survival rate of patients with Dukes B stage carcinoma was 67% （resection alone） , 90% （5-FU/ LV）, and 73% （FOLFOX4） respectively. The 3-year survival rate for patients with Dukes C stage carcinoma was 50% （ resection alone） , 76% （ 5-FU/LV ） , and 86% （ FOLFOX4 ） respectively. The main side effects included anorexia, nausea/vomiting, alopecia and pigmentation. Most of the side effects were tolerable and mild. Condusions Postoperative adjuvant chemotherapy with 5-FU/LV regimen improves the 5-year survival rate in patients with Dukes B stage colorectal carcinoma, and adding L-OHP to this regimen does not further the effect. Compared with 5-FU/LV, FOLFOX4 regimen may further improve the 3-year survival rate of patients with Dukes C stage. And both of the two regimens are safe.