多西他赛联合奥沙利铂及替吉奥治疗进展期胃癌的疗效及对围手术期影响

Efficacy and perioperative effect of docetaxel plus oxaliplatin and S-1 in treating advanced gastric cancer

目的:观察多西他赛+奥沙利铂+替吉奥(DOS方案)治疗进展期胃癌疗效及对手术安全性的评估。方法:应用前瞻性随机对照的方法分析新疆医科大学附属肿瘤医院胃肠外科自2011年1月至2012年5月50例符合入组条件的进展期胃癌患者。按入组顺序根据随机数字表法分为观察组(25例)和对照组(25例)。25例患者术前予以DOS方案化疗(观察组),3个周期化疗后行手术治疗,25例行单纯手术治疗(对照组)。结果:观察组DOS方案新辅助化疗的临床有效率为64.0%,D2淋巴结清扫率(88.0%vs.64.0%)及R0切除率(92.0%vs.68.0%)明显高于对照组(P均<0.05);术后淋巴结转移数目明显少于对照组[(3.2±2.5)枚vs.(6.3±2.9)枚,P<0.05];两组手术时间[(230.5±45.6)min vs.(205.6±42.4)min]及术中出血量[(425.5±115.4)mL vs.(210.6±125.6)mL]比较差异有统计学意义(P<0.05);术后并发症发生率及淋巴结清扫数目两组差异均无统计学意义[(19.6±2.8)枚vs.(21.2±2.0)枚,P>0.05]。观察组患者化疗耐受性良好,不良反应主要为骨髓抑制、消化道反应。结论:DOS方案作为进展期胃癌新辅助化疗方案有效率高,患者耐受性和依从性好。围手术期安全性高,可提高进展期胃癌患者的R0切除率、降低术后淋巴结转移率,能提高近期生存率。

Objective： This study investigates the effect of docetaxel ＋ oxaliplatin ＋ S-1 （DOS program） in treating advanced gastric cancer and surgical safety assessment. Methods： Fifty patients with advanced gastric cancer admitted to the Department of Gastrointestinal Surgery, The Affiliated Tumor Hospital of Xinjiang Medical University between January 2011 and May 2012 were enrolled in this study. These patients were randomized into the observation arm （n=25） and the control group （n=25）. The observer group was administered three cycles of chemotherapy using a DOS program before surgical treatment, whereas the control group underwent surgery. Results： Compared with the control group, the clinical response rate （64.0%）, D2 lymph node dissection rate （88.0% vs. 64.0%）, and R0 resection rate （92.0%vs. 68.0%） in the observation group were significantly higher （P〈0.05）. Moreover, the number of postoperative lymph node metastasis in the observation group was significantly less than that in the control group （3.2±2.5 vs. 6.3±2.9, P〈0.05）. The operative time （230.5 min±45.6 min vs. 205.6 min±42.4 min） and intra-operative blood loss （425.5 mL ±115.4 mL vs. 210.6 mL±125.6 mL） of the two groups were sta-tistically significantly different （P〈0.05）. The incidence of postoperative complications and lymph node sweeping number of the two groups showed no significant difference （19.6 ±2.8 vs. 21.2 ±2.0, P〉0.05）. The patients exhibited good tolerance to chemotherapy, with bone marrow suppression and gastrointestinal reactions as the main adverse effects. Conclusion：The DOS program is a highly efficient, advanced gastric cancer neoadjuvant chemotherapy. The program can improve patient survival and has good patient tolerance and compliance, good peri-operative safety, high R0 resection rate, and low postoperative lymph node metastasis rate.