GEMOX方案和FOLFOX方案一线治疗晚期十二指肠癌的疗效观察

Clinical observation of GEMOX and FOLFOX regimens as first-line chemotherapy for advanced duodenal cancer

目的探讨GEMOX方案和FOLFOX方案一线治疗晚期十二指肠癌的疗效和安全性。方法回顾分析本院2008年6月至2016年1月收治的30例晚期十二指肠癌患者的临床及随访资料,其中10例未接受化疗,20例接受化疗(GEMOX方案9例、FOLFOX方案11例),分别采用RECIST 1.1版与NCI-CTC 4.0版标准评价疗效和不良反应,Kaplan-Meier法进行生存分析。结果 GEMOX方案和FOLFOX方案均无CR和PR病例,其中GEMOX方案获SD 6例、PD 3例,疾病控制率(DCR)为66.7%,FOLFOX方案获SD 4例、PD 7例,DCR为36.4%,两组DCR的差异无统计学意义(P>0.05)。GEMOX方案和FOLFOX方案的中位总生存期(OS)分别为27.9个月和15.2个月(P=0.179);GEMOX方案的中位无进展生存期(PFS)为8.0个月,优于FOLFOX方案的4.4个月,差异有统计学意义(P=0.038)。常见不良反应多为1~2级,主要为白细胞减少、中性粒细胞减少、乏力、恶心、皮疹等。20例接受化疗患者的中位OS为26.9个月,优于10例未接受化疗的4.4个月,差异有统计学意义(P<0.001)。结论化疗可延长晚期十二指肠癌患者的生存时间。GEMOX方案和FOLFOX方案均对晚期十二指肠癌一线治疗有效,且耐受性良好,其中GEMOX方案的中位PFS可能更长。

Objective To evaluate the efficacy and safety of GEMOX and FOLFOX regimens as first-line chemotherapy for advanced duodenal cancer. Methods From June 2008 to Jan 2016, 30 advanced duodenal cancer patients were analyzed. Only 20 patients received chemotherapy, including 9 patients of GEMOX regimen and 11 patients of FOLFOX regimen as first-line chemotherapy. The efficacy and safety were evaluated by RECIST 1.1 and NCI-CTC 4. 0 criteria. Overall survival （OS） and progression-free survival （PFS） were analyzed by Kaplan-Meier method. Results Among patients receiving chemotherapy, CR and PR were not observed. For GEMOX regiem, 6 cases of SD and 3 cases of PD were observed with disease control rate （DCR） of 66. 7%. For FOLFOX regiem, 4 cases of SD and 7 cases of PD were observed with DCR of 36.4%. No difference in DCR was observed between different regimes （P〉 0.05）. The median OS of GEMOX and FOLFOX regimes were 27.9 months and 15.2 months（ P= 0. 179）. The median PFS of GE- MOX regime was 8 months, superior to 4.4 months of FOLFOX regime （P = 0. 038）. The major treatment-related side effects included leucopenia, neutropenia, nausea, vomiting, fatigue, erythra and etc, mainly in gradel-2. The median OS of patients receiving chemotherapy was 26. 9 months, superior to 4. 4 months of patients receiving non-chemotherapy （P〈0. 001 ）. Conclusion Chemotherapy was effective in advanced duodenal cancer. Both GEMOX and FOLFOX regimes were effective and well-tolerated in the first-line chemotherapy. GEMOX had a longer PFS in first-line chemotherapy.