弥漫浸润型胃癌患者术前多西紫杉醇+顺铂+氟尿嘧啶方案化疗的疗效及安全性观察

Therapeutic effect and safety of DCF regimen as pre-operative chemotherapy in the treatment of Borrmann's type Ⅳ gastric cancer

目的探讨多西紫杉醇+顺铂+氟尿嘧啶(DCF)方案应用于弥漫浸润型(BorrmannⅣ)胃癌患者术前化疗的疗效与安全性。方法 44例进展期Borrmann IV型胃癌患者,术前分为化疗+手术组和常规手术组,化疗+手术组患者术前行DCF方案化疗2周期。观察化疗+手术组的化疗毒副反应、CT缓解程度、病理反应程度。评价CT缓解程度与病理反应程度之间的关系。比较两组间R0切除率及生存期的差异。结果化疗+手术组化疗后的毒副反应以恶心、呕吐为主,未出现IV级不良反应。CT缓解程度中总有效率为68.1%,肿瘤控制率为90.9%,降期率27.3%。病理反应分级中有效4例,占18.18%(4/22)。CT缓解程度与病理反应程度无相关性(rs=-0.42,P=0.051)。化疗+手术组的R0切除率明显高于常规手术组,差异有统计学意义(P<0.05)。两组生存期比较差异无统计学意义(P>0.05)。结论 DCF方案应用于Borrmann IV型胃癌术前化疗是安全的,可提高Borrmann IV型胃癌的R0切除率。

Objective To investigate the therapeutic effect of DCF regimen as pre-operative chemotherapy in the treatment of Borrmann＇s type Ⅳ gastric cancer. Methods Forty-four patients with advanced Borrmann＇s type Ⅳ gastric cancer were divided into chemotherapy ＋ operation group and conventional operation group before operation. The chemotherapy ＋ operation group were treated with DCF chemotherapy regimen for 2 cycles. The chemotherapeutic adverse reactions,CT remission degree and pathological response degree were observed. The relationship between the CT remission degree and pathological response degree were analyzed. The R0 resection rate and the survival rate were compared between the two groups. Results The major adverse reactions in the chemotherapy ＋ operation group were nausea and vomiting after chemotherapy. There were no Ⅳ grade adverse reactions. The total effective rate of CT remission was 68. 1%. The tumor control rate was 90. 9%. The tumor down-staging rate was 27. 3%. The effective rate of the pathologic grades was 18. 18%（ 4 /22）. There was no correlation between CT remission and pathological response（ r =-0. 42,P = 0. 051）. The R0 resection rate in the per-operative chemotherapy group was significantly higher than that in the surgery alone group（ P〈0. 05）.There was no statistically significant difference in overall survival between the two groups. Conclusion The per-operative chemotherapy by the DCF regimen for per-operative chemotherapy in advanced Borrmann＇s type Ⅳ gastric cancer is safe that can improve the R0 resection rate.