两种辅助化疗方案对局部进展期胃癌的疗效分析

Curative effect of two adjuvant chemotherapy for local advanced gastric carcinoma

目的比较多西他赛(DCF)和奥沙利铂(FOLFOX)为主方案治疗局部进展期胃癌根治术后的疗效和不良反应。方法回顾性分析2004年1月-2007年12月134例Ⅱ-ⅢB期局部进展期胃癌D2根治术术后接受两组辅助化疗方案:DCF组44例:DCF方案22例(TXT:60mg/m2,d1;DDP 30mg/m2,d1-3,5-Fu 400mg/m2 IVd1;CF 200mg/m2 d1;5-Fu 2.4g/m2 CIV 48h)DF22例不加DDP;FOLFOX组90例(OXA:130mg/m2 d1;5-Fu 400mg/m2 IV d1,CF 200mg/m2 d1;5-Fu 2.4g/m2 CIV 48h)。结果两组中位无病生存时间分别为27个月、43个月,差异无统计学意义(P>0.05),临床分期分层分析两组DFS差异无统计学意义。中位总生存时间分别为52个月、59个月,3年生存率分别为44.2%、68.5%,差异无统计学意义(P>0.05)。不良反应DCF组白细胞减少及脱发的发生率较FOLFOX组高,外周神经毒性发生率较FOLFOX组低,均可耐受。结论两种辅助化疗方案无明显差异,年老体弱患者可能更适合FOLFOX方案。COX模型分析临床分期,分化程度为局部进展期胃癌术后独立预后因素。

Objective To compare the curative effect and toxicity of two adjuvant chemotherapies for local advanced gastric carcinoma with FOLFOX and DCF after radical operation.Methods A total of 134 patients with local advanced gastric carcinoma at stageⅡ or ⅢB who underwent gastrectomy with extended（D2） lymph-node dissection in our hospital from January 2004 to December 2007 were retrospectively analyzed.The patients were divided into DCF group（n=44） and FOLFOX group（n=90）.Of the 44 patients in DCF group,22 were treated with TXT（60mg/m2）for 1 day,DDP（30mg/m2）for 1-3 days,5-Fu（400mg/m2 IV） for 1 day,CF（200mg/m2） for 1 day,5-Fu（2.4g/m2 CIV） for 48h,22 were treated with DF without DDP.Patients in FOLFOX group were treated with OXA1（30mg/m2）for 1 day,5-Fu（400mg/m2 IV） for 1 day,CF（200mg/m2）for 1 day,5-Fu（2.4g/m2 CIV） for 48h in each 21-day cycle.Results The median disease-free survival time of the two groups was 27 months and 43 months,respectively.No statistical difference was found in clinical stage between the two groups.The median total survival time of the two groups was 52 months and 59 months,respectively.The 3-year survival rate was 44.2% and 68.5% for the two groups,respectively.The incidence rate of leukocytopenia and baldness was higher while the incidence rate of peripheral neuritis was lower in DCF group than in FOLFOX group.Conclusion There is no statistical difference in effect of two adjuvant chemotherapies for local advanced gastric carcinoma.Adjuvant chemotherapy with FOLFOX is more suitable for old patients with debility.The clinical stage and the differentiation of local advanced gastric carcinoma according to the Cox proportional hazard regression model is an independent risk factor for the prognosis of its patients.