替吉奥联合奥沙利铂方案在局部进展期胃癌新辅助化疗中的疗效观察

Observation of clinical efficacy of S-1 combined with oxaliplatin in neoadjuvant chemotherapy for local advanced gastric carcinoma

目的 观察替吉奥胶囊（S-1）联合奥沙利铂新辅助化疗方案（SOx）在局部进展期胃癌治疗中的临床疗效.方法 回顾性分析68例局部进展期胃癌患者临床病理资料,并将此列为治疗组.该组患者术前均行SOX方案化疗3～4个周期.依据实体瘤评估标准（RECISI 1.1版）评价患者新辅助化疗后的肿瘤缓解情况.同时选取同一时期的未经新辅助化疗而直接手术的局部进展期胃癌患者70例作为对照组.比较两组患者的手术切除率、R0切除率、术后并发症发生率以及术后无进展生存（PPFS）时间.结果 治疗组接受新辅助化疗后的完全缓解（CR）4例（5.9％）,部分缓解（PR）36例（52.9％）,病情稳定（SD）15例（22.1％）,病情进展（PD）13例（19.1％）,客观缓解率为58.8％,疾病控制率为80.9％,手术切除率为92.6％,根治性切除率为85.3％,并发症发生率为14.7％.治疗组根治性切除率明显高于对照组,差异有统计学意义（χ2=8.042,P ＜0.05）,但两组手术切除率和并发症发生率差异均无统计学意义（χ2=1.711、0.673,均P＞0.05）.治疗组、对照组的中位PPFS分别为36个月、30个月,两组差异有统计学意义（χ2=4.049,P＜0.05）.结论 S-1联合奥沙利铂新辅助化疗方案在局部进展期胃癌治疗中的近期疗效令人满意,且能提高PPFS.但对患者术后总生存的影响尚需进一步的研究.

Objective To observe the clinical efficacy of S-1 plus oxaliplatin （SOX） in neoadjuvant chemotherapy for patients with local advanced gastric carcinoma.Methods Clinicopathological data of 68 patients with local advanced gastric cancer were retrospectively analyzed and enrolled as treatment group.All the patients in the treatment group achieved 3-4 cycles chemotherapy of SOX regimen preoperatively.Outcomes of tumor remission after neoadjuvant chemotherapy were evaluated according to RECISI1.1 criteria.Meanwhile,70 patients who underwent operation directly after pathological diagnosis of local advanced gastric cancer during the same period were recruited as control group.Resection rate,R0 resection rate,postoperative complications rate and postoperative progression free survival（PPFS） time were compared between the two groups.Results In the treatment group,after neoadjuvant chemotherapy,4 cases （5.9%） achieved complete renission,36 cases （52.9%） achieved partial remission.Meanwhile,the numbers of cases with stable disease and progressive disease were 15 cases（22.1%） and 13 cases （19.1%） respectively.The objective remission rate and disease control rate in the treatment group were 58.8% and 80.9% respectively.The tumor resection rate,R0 resection rate,postoperative complications rate in the treatment group were 92.6%,85.3% and 14.7% respectively.The R0 resection rate in the treatment group was higher than that in the control group,the difference was statistically significant（χ2 =8.042,P 〈 0.05）.However,the differences of tumor resection rate and postoperative complications rate between the two groups were not statistically significant （χ2 =1.711,0.673,all P 〉 0.05）.The median time of PPFS in the treatment group and the control group was 36 months and 30 months respectively,there was statistically significant difference in PPFS between the two groups （χ2 =4.049,P 〈 0.05）.Conclusion The neoadjuvant chemotherapy of S-1 plus oxaliplatin for local advanced gastric carcminoma has satisfactory short-term effect and can also improve PPFS.However,further investigation is required to observe the effect of this neoadjuvant chemotherapy regimen on postoperative overall survival.