替吉奥联合顺铂与替吉奥联合奥沙利铂一线治疗晚期胃癌的比较研究

S-l plus cisplatin versus S-1 plus oxaliplatin for first-line treatment of advanced gastric cancer

目的比较替吉奥(S-1)联合顺铂(DDP)与S-1联合奥沙利铂(L-OHP)一线治疗晚期胃癌的疗效和安全性。方法回顾性分析2007年1月至2010年10月收治的51例晚期胃癌患者,其中S-1+DDP组24例,具体为:S-1 40mg/m2口服,每天2次,第1～21天;DDP 20mg/m2静滴,第1～4天,4周为1周期。S-1+L-OHP组27例,具体为:S-1 40mg/m2口服,每天2次,第1～14天;L-OHP 130mg/m2静滴3h,第1天,3周为1周期。结果 51例患者均可评价毒副反应,49例可评价近期疗效,46例可评价远期疗效。S-1+DDP组和S-1+L-OHP组的有效率分别为27.2%和44.4%(P=0.144),临床受益率分别为59.1%和70.3%(P=0.221),中位肿瘤进展时间分别为4.6个月和9.0个月(P=0.048),中位总生存时间分别为10.0个月和11.0个月(P=0.136)。S-1+DDP组的白细胞减少、贫血、血小板减少、恶心、呕吐、疲乏的发生率均较S-1+L-OHP组多见,但差异无统计学意义;S-1+DDP组的发热及感染、3～4级中性粒细胞减少的发生率明显高于S-1+L-OHP组(P<0.05),S-1+L-OHP组的神经毒性发生率高于S-1+DDP组(P<0.05)。结论 S-1+L-OHP方案一线治疗晚期胃癌较S-1+DDP方案的中位肿瘤进展时间延长以及严重中性粒细胞减少的发生率显著降低,值得临床进一步研究。

Objective To evaluate the efficacy and toxicity of S-1 in combination with cisplatin（DDP） or oxaliplatin（L-OHP） in patients with advanced gastric cancer.Methods Fifty-one patients with advanced gastric cancer collected from January 2007 to October 2010 in our department were divided into two groups： Group S-1＋DDP with 24 patients（S-1 40mg/m2 po,bid,d1-d21;DDP 20mg/m2iv,d1-d4.Four weeks was a cycle） and Group S-1＋L-OHP with 27 patients（S-1 40mg/m2 po,bid,d1-d14;L-OHP 130mg/m2 iv,d1.Three weeks was a cycle）.Results Toxicity could be evaluated in all the patients,response rate could be evaluated in 49 patients,overall survival could be evaluated in 46 patients.In Group S-1＋DDP and Group S-1＋L-OHP,the response rate was 27.2% and 44.4%（P=0.144）,the disease control rate was 59.1% and 70.3%（P=0.221）,the median time to progress was 4.6 months and 9.0 months（P=0.048）,and the median overall survival was 10 months and 11 months（P=0.136）.Side effects included leucopenia,anaemia,thrombocytopenia,nausea,vomiting and fatigue were more common in the Group S-1＋DDP without statistic significance.There were more fever and infection and grade 3-4 neutrocytopenia（P0.05） in the Group S-1＋DDP,and more neurotoxicity in the Group S-1＋L-OHP（P0.05）.Conclusion The benefit of S-1 combined with L-OHP regimen is over S-1 combined with DDP regimen in the time to progress in patients with advanced gastric cancer,and with significant less incidence rate of grade 3-4 neutrocytopenia in S-1 combined with L-OHP regimen.These results indicate that further clinical study is of great worth.