全反式维甲酸及腹腔化疗对进展期胃癌手术后患者生存期的影响

The effect of all-trans retinoid acid in combination with intraperitoneal chemotherapy on postoperative survival of patients with advanced gastric cancer

目的:探讨全反式维甲酸(all-trans retinoid acid,ATRA)诱导分化治疗及细胞毒药物腹腔化疗对进展期胃癌手术后患者生存期的影响。方法:248例进展期胃癌手术后患者按照均衡循序随机的方法分为腹腔灌注化疗组(氟尿嘧啶联合顺铂方案)、静脉化疗组(氟尿嘧啶、亚叶酸钙联合顺铂方案)、腹腔灌注化疗+ATRA组和静脉化疗+ATRA组,随访患者治疗后的生存时间。结果:全组随访1～139个月,中位随访时间为37个月。进展期胃癌手术后患者以ATRA治疗,其生存期较未用ATRA治疗者的生存期明显延长[风险比(hazard ratio,HR)=0.52,95%可信区间(confidence interval,CI)=0.37～0.72,P<0.001];腹腔灌注化疗+ATRA组和静脉化疗+ATRA组进展期胃癌手术后患者的3和5年生存率分别高于腹腔灌注化疗组和静脉化疗组,腹腔灌注化疗+ATRA组患者的中位生存时间为5.17年,静脉化疗+ATRA组患者的中位生存时间为3.70年。结论:腹腔灌注化疗结合ATRA诱导分化治疗可延长进展期胃癌手术后患者的生存时间。

Objective： To investigate the effect of ATRA （all-trans retinoid acid）-induced differentiation and IPC （intraperitoneal chemotherapy） with cytotoxic agents on postoperative survival of patients with advanced gastric cancer. Methods： Total of 248 paitents received surgery for stomach cancer. After operation, they were randomly divided into four groups which were IPC group （5-fluorouracil plus cisplatin）, systemic chemotherapy group （5-fluorouracil, leucovorin plus cisplatin, FLP）, IPC plus oral ATRA group, and FLP plus oral ATRA group. All the patients in these four groups were followed-up. Results： The median follow-up time was 37 months （range： 1-139 months）. The treatment with ATRA- induced differentiation could achieve significant benefit in prolonging postoperative survival of patients with advanced gastric carcinoma as compared with no ATRA treatment [HR （hazard ratio）： 0.52, 95% CI （confidence interval）： 0.37-0.72; P 〈 0.001]. The three- and five-year survival rates were higher in IPC plus ATRA group than those in IPC group, meanwhile the three- and five-year survival rates were also higher in FLP plus ATRA group than those in FLP group. The median survival time was 5.17 years in IPC plus ATRA group and 3.70 years in FLP plus ATRA group. Conclusion： The survival time of patients after operation for advanced gastric cancer may be prolonged due to treatment with IPC in combination with ATRA-induced differentiation.