改良DCF与XELOX方案治疗老年晚期胃癌的疗效及安全性分析

The efficacy and safety of modified DCF regimen and XELOX regimen in elderly patients with advanced gastric cancer

目的：研究改良DCF（m DCF）与XELOX方案一线治疗老年晚期胃癌的疗效及药品不良反应。方法：回顾性分析2010年1月–2013年12月我院收治的确诊时已有远处转移的胃癌患者,筛选出年龄≥65岁且一线化疗使用m DCF或XELOX方案,共计60例,其中m DCF组22例,XELOX组38例,收集患者的各项临床资料,比较两组的客观有效率（ORR）、疾病控制率（DCR）、无进展生存时间（PFS）、总生存时间（OS）。结果：m DCF组近期疗效优于XELOX组,且PFS与OS均较XELOX组延长,两组PFS间差异有统计学意义（14.2个月vs 5.8个月,P=0.002）,但OS间差异无统计学意义（20.8个月vs 12.0个月,P=0.107）。Cox多因素分析显示：化疗方案是PFS的独立预后指标（HR 2.461;95%CI 1.308~4.628;P=0.005）,但未发现对OS有影响（P=0.747）;对于恶心呕吐、白细胞降低等药品不良反应的发生率m DCF方案明显高于XELOX方案,对于外周神经毒性、手足综合征等药品不良反应的发生率XELOX方案明显高于m DCF方案,但所有药品不良反应的Ⅲ、Ⅳ级发生率均较低。结论：老年患者中,应用m DCF方案及XELOX方案的总生存时间无显著性差异,药品不良反应均可耐受,但m DCF方案较XELOX方案近期效果好,无进展生存时间延长。

Objective： To investigate the efficacy and adverse drug reaction of modified DCF （mDCF） regimen and XELOXregimen as first-line chemotherapy in elderly patients with advanced gastric cancer. Methods： From January 2010 to December2013, 60 patients diagnosed with metastases and treated with first-line chemotherapy of mDCF or XELOX regimen in our hospitalwere analyzed retrospectively. The ages of the patients were all greater than 65, mDCF group contained 22 cases, while XELOXgroup included 38 cases. The clinical data of these 60 patients were collected. The objective response rates （ORR）, disease controlrates （DCR）, progression-free survival （PFS） and overall survival （OS） were compared between the two groups. Results： The shorttermeffect of mDCF regimen was better than that of XELOX regimen, and either PFS or OS was longer than XELOX group. Therewas statistically significant difference in PFS between the two groups （14.2 vs 5.8 months, P = 0.002）, but the difference of OS wasnot statistically significant （20.8 vs 12.0 months, P = 0.107）. Multivariate Cox analysis showed that chemotherapy was a independentprognostic indicator of PFS （HR 2.461; 95%CI 1.308 – 4.628; P = 0.005）, but no significant association was found betweenchemotherapy and OS （P = 0.747）. The incidence of nausea, vomit and leukopenia were higher in mDCF regimen group than that ofXELOX group, while the incidence of peripheral neurotoxicity and hand-foot syndrome was lower in mDCF group. But the toxicitieswere rarely in grade Ⅲ – Ⅳ. Conclusion： In elderly patients, both mDCF regimen and XELOX regimen have similar overallsurvival time, and toxicities are all tolerated. However, mDCF regimen has better short-term efficacy and prolonged progression-freesurvival time.