含紫杉醇方案一线治疗379例进展期胃癌的临床观察

The clinical observation of 379 patients with advanced gastric cancer treated with paclitaxel-containing chemotherapy regimens

目的评价以紫杉醇为基础的联合化疗方案一线治疗进展期胃癌的疗效和安全性,为进展期胃癌的一线治疗策略制定提供依据。方法回顾性分析本院2003年1月至2008年12月收治的379例进展期胃癌患者,根据化疗方案实施情况分为4组:紫杉醇+奥沙利铂+亚叶酸钙+氟尿嘧啶(A组,n=95)、紫杉醇+亚叶酸钙+氟尿嘧啶(B组,n=167)、紫杉醇+奥沙利铂(C组,n=94)和单药紫杉醇(D组,n=23)。分析4组的有效率(RR)、疾病控制率(DCR)、无进展生存期(PFS)和总生存期(OS)及治疗期间的毒副反应。结果 A、B、C和D组的RR分别为47.3%、52.1%、60.0%和39.1%,DCR分别为89.2%、92.6%、89.5%和69.6%,中位OS分别为11.4、11.7、11.7和7.5个月,中位PFS分别为6.6、7.2、7.2和4.1个月。3～4级不良反应中仅白细胞减少在4组中的发生率均超过25.0%,其余3～4级不良反应发生率低于20.0%;A组中3～4级恶心呕吐、疲乏及白细胞减少的发生率高于其余3组(P<0.05)。结论以紫杉醇为基础的联合化疗方案可作为进展期胃癌的一线治疗方案。

Objective To evaluate the efficacy and safety of the paclitaxel-containing chemotherapy regimens as the first-line treatment for advanced gastric cancer. Methods In this retrospective analysis, 379 patients with advanced gastric cancer were divided into four groups based on their chemotherapy regimens ： group A （ paclitaxel ＋ oxaliplatin ＋ calcium folinate ＋ fluorouracil, n = 95 ） , group B （ paclitaxel ＋ calcium folinate ＋ fluorouraeil, n = 167 ） , group C （ paclitaxel ＋ oxaliplatin, n = 94 ） and group D （ paclitaxel a- lone, n = 23 ）. The response rate （RR） , disease control rate （DCR） , progression-free survival（PFS） and overall survival（OS） as well as toxicity during treatment were investigated among four groups. Results The RR and DCR of group A, B, C and D were 47.3% and 89.2% , 52.1% and 92. 6% , 60.0% and 89.5% , 39. 1% and 69.6% , respectively. Meanwhile, the median OS and PFS were 11.4 and 6. 6 months, 11.7 and 7.2 months, 11.7 and 7.2 months, 7.5 and 4. 1 months, respectively. The incidence of grade 3-4 toxicities were lower than 20. 0% among four groups despite the grade 3-4 leukopenia with the incidence more than 25.0%. The grade 3-4 nause/vomitting, fatigue and leukopenia in group A were higher than those in other 3 groups （P 〈 0. 05 ）. Conclusion The pacli- taxel-containing chemotherapy regimens can be the first-line chemotherapy regimens for the advanced gastric cancer.