老年晚期胃癌两药联合和三药联合治疗方案的对比研究

The first-line treatment options of elderly patients with advanced gastric cancer

目的 比较奥沙利铂联合氟尿嘧啶的联合方案和含紫杉类、顺铂、5-氟尿嘧啶（5-Fu）的联合方案在治疗老年晚期胃癌中的临床疗效及不良反应发生情况,衡量两种不同方案的临床疗效和耐受性.方法 对73例进行过相关方案化疗的老年晚期胃癌患者进行回顾性分组分析.化疗方案包括：A组采用奥沙利铂联合氟尿嘧啶方案（FOLFOX4、FOLFOX6、国内改良OXL＋5-Fu）,B组采用合紫杉类、顺铂、5-Fu的联合方案（TCF、DCF）.对两组的临床疗效、生活质量、不良反应进行比较.结果 A组和B组的有效率分别为41.5%（17/41）和50.0%（16/32）,差异无统计学意义（P=0.467）.A组的不良反应主要表现为血液学毒性（白细胞计数降低80.5%,贫血63.4%,血小板计数降低29.3%）,周围神经毒性68.3%,上消化道反应58.5% B组主要的不良反应包括上消化道反应100%,血液学毒性（白细胞计数降低81.2%,贫血68.75%,血小板计数降低40.6%）,脱发81.25%,腹泻31.25%.A组上消化道反应、腹泻和脱发发生率明显低于B组（P=0.000,0.046和0.000）,但是其周围神经毒性显著高于B组（P＜0.05）.血液学毒性A组低于B组,但差异无统计学意义（P＞0.05）.结论 奥沙利铂联合氟尿嘧啶的方案和含紫杉类、顺铂、5-Fu的联合方案在治疗老年晚期胃癌上近期疗效相当,患者均耐受良好,而奥沙利铂联合氟尿嘧啶的联合方案不良反应发生率更低,表现出了更好的耐受性.

Objective To evaluate the efficacy and adverse effects of oxaliplatin （OXL）combined with 5-fluorouracil（5-Fu） and taxol combined with 5-Fu, cisplantin in the treatment of elderly patients with advanced gastric cancer. Methods Seventy-three elderly patients with advanced gastric cancer admitted in our department from 2004 to 2010 received OXL combined with 5-Fu（ group A） or taxol combined with 5-Fu, cisplantin （group B）. The chemotherapy regimens of group A included：FOLFOX4, FOLFOX6 and similar adjust-regimens in china. The chemotherapy regimens of group B ineluded： TCF and DCF. Comparing the efficacy and adverse effects of the two groups. Results All patients could be evaluated for therapeutic efficacy. The efficacy of the two groups were 41.5%（17/41）and 50%（16/32）, there was no significant difference（ P =0.467）. The adverse effects of group A included hematologic toxicity（leukopenia 80.5%）, peripheral nerve toxicity 68.3%, nausea 58.5% the adverse effects of group B included nausea 100%, hematologic toxicity （ leukopenia 81.2% ）, hair Loss 81.25%, diarrhea 31.25%. Nausea, hair Loss, diarrhea in group B was statistically higher than those in group A（P =0.000,0.046 and 0.000, respectively）. Peripheral nerve toxicity in group A was statistically higher than that in group B. Conclusions This study shows that the regimen of OXL combined with 5-Fu is effective, compared with taxol combined with 5-Fu and cisplantin in elderly patients with advanced gastric cancer. And the tolerance is well. There is less adverse effects in OXL combined with 5-Fu.