新辅助化疗在局部进展期胃食管交界腺癌治疗中的应用研究

Application of neoadjuvant chemotherapy in the treatment of locally advanced esophagogastric junction adenocarcinoma

目的观察新辅助化疗结合手术治疗局部进展期胃食管交界(EGJ)腺癌的临床效果。方法选择2012年3月至2014年1月期间江苏省扬中市人民医院收治的81例局部进展期EGJ腺癌患者,按照随机数表法分为治疗组和对照组。治疗组41例患者给予卡培他滨和奥沙利铂联合或不联合紫杉醇的方案化疗2~4周期,再进行手术治疗及术后辅助化疗2~4周期。对照组40例患者直接进行手术治疗,术后给予卡培他滨和奥沙利铂联合或不联合紫杉醇的方案辅助化疗4~6周期。比较分析两组患者的术后病理分期、手术并发症、药物毒性不良反应及无病生存期。结果治疗组术后T分期及N分期较对照组提前;两组均未出现致死性并发症,治疗组发生率为4.9%(2/41),对照组发生率为22.5%(9/40),两组并发症发生率差异有统计学意义(χ~2=5.357,P=0.021)。结论新辅助化疗方案治疗局部进展期EGJ腺癌疗效安全确切,能够降低分期,延迟复发,提高无病生存期,对患者生存有益,值得临床推广。

Objective：To observe the clinical effect of neoadjuvant chemotherapy combined with surgery in the treatment of local advanced gastric-esophageal junction （EGJ） adenocarcinoma. Methods Eighty-one patients with locally advanced EGJ adenocarcinoma admitted to the Department of Oncology in Yangzhong City People＇s Hospital from March 2012 to January 2014 were divided into treatment group and control group according to the random number table. Treatment group of 41 patients underwent capecitabine and oxaliplatin combined with or without paclitaxel chemotherapy for 2 to 4 cycles, and then surgery and postoperative adjuvant chemotherapy for 2 to 4 cycles. Forty patients of the control group were treated surgically with capecitabine and oxaliplatin in combination with or without paclitaxel for 4 to 6 cycles. Comparative analysis was carried out of postoperative pathological staging, surgical complications, adverse drug reactions and disease-free survival of the two groups of patients. Results：There were no fatal complications in the treatment group, while the incidence rate was 4.9% （2/41） in the treatment group and 22.5% （9/40） in the control group. The incidence of complications was statistically significant （χ2=5.357, P=0.021）. Conclusions：Neoadjuvant chemotherapy regimens in the treatment of locally advanced gastric-esophageal junctions is safe and accurate. It can reduce staging, delay recurrence, improve disease-free survival and benefit patients. It is worthy to be popularized.