含多西他赛方案一线治疗进展期胃癌的临床观察

Clinical Observation on Docetaxel Chemotherapy in the First-line Treatment of Advanced Gastric Cancer

目的探讨含多西他赛的四种不同一线化疗药物对进展期胃癌的治疗效果。方法选择苏州大学附属第一人民医院肿瘤科2012年7月至2014年6月收治的246例胃癌患者（进展期）为研究对象,根据化疗方案不同分为4组：多西他赛＋DDP＋5-fu（A组,n=32）、多西他赛＋奥沙利铂＋卡培他滨（B组,n=80）、多西他赛＋奥沙利铂（C组,n=118）和多西他赛＋卡培他滨（D组,n=16）。分析4组的有效率（RR）、疾病控制率（DCR）、无进展生存期（PFS））及治疗期间的不良反应等。结果 A、B、C和D组的RR分别为46.9%、48.8%、45.8%和37.5%,A组、B组、C组的RR均高于D组,差异有统计学意义（P〈0.05）;DCR分别为87.5%、91.3%、87.3%和87.5%,4组比较差异无统计学意义（P〉0.05）。4组中位PFS分别为7.8、8.2、8.0和7.5个月。在4组患者中,3~4级不良反应：白细胞减低发生率均超过15.0%,而其余不良反应发生率均低于10.0%;A、B组恶心呕吐、乏力及白细胞减少等不良反应发生率均高于其他两组（P〈0.05）。结论根据患者不同状况,以多西他赛为基础的多药联合,可作为进展期胃癌的一线治疗方案。

Objective To explore the effects of 4 kinds of docetaxel-containing first-line chemotherapy drugs in the treatment of advanced gastric cancer.Methods 246 patients with advanced gastric cancer were divided into 4 groups according to chemotherapy regimens,namely,docetaxel combined with DDP and 5-fu group（ group A,n = 32）,docetaxel combined with oxaliplatin and capecitabine group（ group B,n = 80）,docetaxel combined with oxaliplatin group（ group C,n = 118） and docetaxel combined with capecitabine group（ group D,n = 16）.The response rate（ RR）,disease control rate（ DCR）,progression-free survival（ PFS） and adverse reactions during treatment of the 4 groups were investigated.Results RR of group A,group B,group C and group D were 46.9%,48.8%,45.8% and 37.5%,respectively.RR of group A,group B and group C were higher than that of group D（ P 0.05）.DCR were 87.5%,91.3%,87.3% and 87.5%,respectively（ P 0.05）.The median PFS were 7.8months,8.2 months,8.0 months and 7.5 months,respectively.As for the incidence of grade 3 ~ 4 side effects in the 4 groups,the incidence of leukopenia was higher than 15.0%,while the incidence of other adverse reactions was lower than 10.0%; The incidence rates of nausea / vomitting,fatigue and leukopenia in group A and group B were higher than those of the other 2 groups（ P 0.05）.Conclusion Docetaxel-containing multi-drug treatment can be used as the first-line chemotherapy for advanced gastric cancer according to the different condition of patients.