新辅助化疗联合胃癌根治术治疗进展期胃癌的临床疗效

Clinical efficacy of neoadjuvant chemotherapy combined with radical gastrectomy for advanced gastric cancer

目的：探讨新辅助化疗联合胃癌根治术治疗进展期胃癌的临床疗效。方法：采用回顾性横断面研究方法。收集2004年6月至2009年12月浙江大学医学院附属第一医院收治的73例行新辅助化疗联合胃癌根治术的进展期胃癌患者的临床病理资料。新辅助化疗方案包括XELOX和FOLFOX两种。新辅助化疗结束后2周内行胃癌根治术。术后按新辅助化疗方案继续化疗。观察指标：（1）新辅助化疗不良事件。（2）手术及术后情况。（3）随访情况。采用门诊和电话方式进行随访，了解患者生存情况。随访时间截至2014年12月。偏态分布的计量资料以M（范围）表示。总体生存时间定义从患者治疗开始到死亡或末次随访（对于失访患者）的时间。疾病无进展生存时间定义为从患者治疗开始到肿瘤进展、复发、远处转移或死亡的时间。采用KaplanMeier法绘制生存曲线。结果：（1）新辅助化疗不良事件：73例患者中， 38例采用XELOX方案，35例采用FOLFOX方案；新辅助化疗中位周期为3个（1～7个）。73例患者行新辅助化疗期间，55例发生不良事件，其中1～2级47例，3～4级8例。（2）手术及术后情况：73例患者均成功完成D2胃癌根治术，其中全胃切除术40例，远端胃切除术31例，全胃联合横结肠切除术1例，远端胃联合胆囊切除术1例。73例患者中，10例发生术后并发症，其中胸腔积液3例、腹腔积液2例、吻合口出血 2例、胆囊炎2例、淋巴液漏1例。并发症均经保守治疗后好转，无行二次手术或术后30 d内死亡患者。病理学TNM分期：Ⅰ～Ⅱ期22例，Ⅲ期45例，Ⅳ期4例，无法分期2例（T0N1M0期）。3例患者完全缓解（T0N0M0期）。术后43例患者行化疗。（3）随访情况：73例患者均获得术后随访，随访时间为8～125个月，中位随访时间为51个月。73例患者中位生存时间为52个月，5年总体生存率为41.1%，5年疾病无进展生存率为34.2%。结论：XELOX和FOLFOX新辅助化疗联合胃癌根治术治疗进展期胃癌安全有效。

Objective：To investigate the clinical efficacy of neoadjuvant chemotherapy combined with radical gastrectomy for advanced gastric cancer. Methods：The retrospective crosssectional study was conducted. The clinicopathological data of 73 patients who underwent neoadjuvant chemotherapy combined with radical gastrectomy for advanced gastric cancer at the First Affiliated Hospital of Zhejiang University between June 2004 and December 2009 were collected. Neoadjuvant chemotherapy regimens included XELOX and FOLFOX. Patients received radical gastrectomy within 2 weeks after the completion of the last cycle of neoadjuvant chemotherapy and then continued to undergo postoperative neoadjuvant chemotherapy. Observation indicators： （1） adverse event of neoadjuvant chemotherapy; （2） surgical and postoperative situations; （3） followup situations. Followup using outpatient examination and telephone interview was performed to detect survival of patients up to December 2014. Measurement data with skewed distribution were described as M （range）. Overall survival time was from the beginning of treatment to death or end of followup （patients with loss to followup）. Progressionfree survival time was from the beginning of treatment to tumor progression, recurrence and metastasis or death. The survival curve was drawn by the KaplanMeier method. Results： （1） Adverse event of neoadjuvant chemotherapy： of 73 patients, 38 received XELOX regimens and 35 received FOLFOX regimens, with a median cycle of 3 （range,1-7 cycles）. There were 55 adverse events during neoadjuvant chemotherapy, including 47 with grade 1-2 and 8 with grade 3-4. （2） Surgical and postoperative situations： all the 73 patients underwent successful D2 radical gastrectomy for gastric cancer, including 40 receiving total gastrectomy, 31 receiving distal gastrectomy, 1 receiving total gastrectomy with transverse colon resection and 1 receiving distal gastrectomy with cholecystectomy. Of 73 patients, 10 with postoperative complications were improved by conservative treatment, including 3 with pleural effusion, 2 with peritoneal effusion, 2 with anastomotic bleeding, 2 with cholecystitis and 1 with lympha fistula. No patient received reoperations or died within 30 days postoperatively. Pathological TNM staging： 22 patients were detected in stageⅠ-Ⅱ,45 in stage Ⅲ,4 in stage Ⅳ and 2 in stage T0N1M0. Three patients （in stage T0N0M0） had complete remission. Fortythree patients underwent postoperative chemotherapy. （3） Followup： all the 73 patients were followed up for 8-125 months, with a median time of 51 months. The median survival time, 5year overall survival rate and 5year diseasefree survival rate of 73 patients were 52 months, 41.1% and 34.2%, respectively. Conclusion：XELOX and FOLFOX regimens of neoadjuvant chemotherapy combined with radical gastrectomy for advanced gastric cancer are safe and effective.