不可切除的局部进展期胃癌术前口服S-1联合区域动脉灌注化疗栓塞的疗效评价

Preoperative oral S-1 plus regional intra-arterial chemoembolization for patients with unresectable locally advanced gastric cancer

目的:探讨不可切除的局部进展期胃癌术前口服替吉奥胶囊(gimeracil and oteracil porassium capsules,S-1)联合区域动脉灌注化疗栓塞的有效性及安全性.方法:回顾性分析郑州大学第一附属医院胃肠外科2010-01/2014-06收治的183例接受新辅助化疗后行手术切除的局部进展期胃癌患者的临床资料,其中术前口服S-1联合区域动脉灌注化疗栓塞者90例(A组),术前全身静脉化疗者93例(B组),A组与B组两组患者完成术前化疗后,于3-4 wk内按照标准D2根治性手术操作要求进行手术.比较两组术后组织病理学疗效、化疗不良反应发生率及术后并发症发生率.结果:两组术后标本的组织病理学评估均有效,A组和B组的疗效满意率分别为60%、43%,差异有统计学意义(χ2=5.285,P<0.05);A组织化学疗不良反应(除外恶心反应)和术后吻合口瘘、肠梗阻、切口愈合不良、腹腔感染及肺部感染等并发症发生率均低于B组,而恶心反应发生率高于B组;两组均无新辅助化疗治疗相关死亡病例.结论:不可切除的局部进展期胃癌术前口服S-1联合区域动脉灌注化疗栓塞的疗效确切,可降低化疗不良反应,且不增加术后并发症的发生率.

AIM： To investigate the efficacy and safety of preoperative oral gimeracil and oteracil porassium capsules （S-1） chemotherapy combined with regional intra-arterial chemoembolization in the treatment of unresectable locally advanced gastric cancer. METHODS： Clinical data for 183 patients with unresectable locally advanced gastric cancer who received operation after receiving neoadjuvant chemotherapy from January 2010 to June 2014 were retrospectively analyzed. Patients were divided into two groups： those who received preoperative oral S-1 chemotherapy plus regional intra-arterial chemoembolization （group A, n = 90） and those who received preoperative systemic chemotherapy （group B, n = 93）. Radical resection was performed after 3 to 4 weeks for those who had resectable lesions. RESULTS： The overall satisfactory rate was significantly higher （60%） in group A compared with 43% in group B （x2 = 5.285, P 〈 0.05）. The incidence rates of toxicities （except nausea） and postoperative complications such as anastomotic leakage, intestinal obstruction, poor wound healing, abdominal infection and pulmonary infection were all significantly lower in group A than in group B （P 〈 0.05 for all）, while the incidence rate of nausea was significantly higher in group A than in group B （Z2 = 17.402, P 〈 0.01）. There was no perioperative mortality related to neoadjuvant therapy in the two groups. CONCLUSION： Preoperative oral S-1 chemot- herapy combined with regional intra-arterialchemoembolization is associated with better efficacy, and fewer toxicities and postoperative complications in the treatment of unresectable locally advanced gastric cancer.