局部进展期胃癌术前化疗的疗效分析

Efficacy of neoadjuvant chemotherpy in patients with locally advanced gastric cancer

目的探讨局部进展期胃癌术前化疗的疗效及安全性，以及影响术前化疗胃癌患者复发死亡的因素。方法回顾性分析2007年7月至2011年6月间复旦大学附属中山医院肿瘤内科收治的49例局部进展期胃癌患者的临床资料。采用Cox比例风险模型来分析新辅助化疗患者复发死亡的危险因素。结果其中48例患者化疗后在术前接受了影像学评估，术前化疗的有效率和疾病控制率分别为33．3％（16／48）和93．8％（45／48）；另有1例因在化疗期间胃穿孔行急诊手术而未接受影像学评估。治疗后89．8％（44／49）的患者获得根治手术，其中90．9％的患者（40／44）接受了D2淋巴结清扫术。术后淋巴结转阴率为30．6％（15／49）；术后病理有反应32例，其中2例获得完全病理缓解。术前化疗期间血液学毒性反应主要为白细胞下降，非血液学毒性反应主要为恶心呕吐，以1-2级为主。49例患者平均住院时间为11．6d，其中2例（4．1％）分别因术后胰漏和胰周渗液而延长了住院时间。49例患者均接受了术后随访，中位随访时间为21．6个月，中位无复发生存期为29．6个月（95％CI：24．0～35．2），中位总生存期为34．6个月（95％CI：29．8～39-4）。多因素预后分析显示，影像学疗效（阵0．038，RR=O．168，95％CI：0．031～0．904）和病理反应（P=0．007，RR=O．203，95％a：0．064-0．642）是影响本组患者术后复发死亡的独立因素。结论术前化疗对于局部进展期胃癌具有较高的疾病控制率和R。切除率：影像学疗效和病理反应是影响局部进展期胃癌术前化疗患者最重要的预后指标。

Objective To evaluate the efficacy and safety of neoadjuvant chemotherapy in patients with locally advanced gastric cancer, and to analyze the relevant factors of recurrent death of gastric cancer after adjuvant chemotherapy. Methods Clinical data of 49 patients who underwent neoadjuvant chemotherapy for locally advanced gastric cancer between July 2007 and June 2011 were reviewed. Preoperative staging was determined by endoscopic uhrasonography and abdominal computer tomography（CT） or magnetic resonance imaging（MRI）. Chemotherapy was administered for regimen of two or three drugs. Prognostic factors were analyzed by univariate and multivariate analysis with Cox proportional hazard model. Results The response rate was 33.3%（16/48） and disease control rate was 93.8% （45/48）. Forty-four （ 89.8%, 44/49） patients received curative resection after neoadjuvant chemotherapy, among whom 90.9% （40/44） underwent D2 lymphadenctomy. Thirty-two cases had pathological response and 2 patients had pathological complete response. The average hospital stay was 11.6 days and 2 patients had longer hospitalization because of postoperative pancreatic complications. The toxicities were most in grade 1-2. All the patients were followed up postoperatively and the medianfollow-up was 21.6 months. Median progression-free survival was 29.6（95%CI： 24.0-35.2） months and median overall survival was 34.6 months （95%CI：29.8-39.4）. Imaging response（P=0.038, RR=0.168, 95%CI：0.031-0.904） and pathological response （P=0.007, RR=0.203, 95%CI：0.064-0.642） were identified as independent prognostic factors with COX multivariate analysis. Conclusions Neoadjuvant chemotherapy has quite high disease control rate and R0 resecting rate for patients with locally advanced gastric cancer. Imaging response and pathological response are most important prognostic factors in those patients.