奥沙利铂联合替吉奥方案新辅助化疗对进展期Ⅲ期胃癌病人围手术期影响研究

Effect of neoadjuvant chemotherapy with oxaliplatin and S-1 regimen on perioperative period of patients with advanced stage Ⅲ gastric cancer

目的探讨奥沙利铂+替吉奥(SOX)方案新辅助化疗对进展期Ⅲ期胃癌病人围手术期的影响。方法回顾性分析2013年1月到2017年1月在潍坊市人民医院肿瘤外科接受治疗的161例进展期Ⅲ期胃癌病人的临床病理学资料,分为新辅助化疗组(75例)和传统治疗组(86例),比较两组病人围手术期的变化情况,新辅助化疗组行进一步分层分析,比较有反应组和无反应组在化疗前后病人的营养状况变化。结果新辅助化疗组及传统治疗组在性别、年龄、发病部位、病理学类型、术前分期及手术方式方面差异无统计学意义(P>0.05)。且两组在手术时间、术中出血量、术后排气时间、术后恢复进食时间、切口拆线时间、淋巴结清扫数目、引流量和术后住院时间以及术后并发症的发生率方面差异无统计学意义(P>0.05)。新辅助化疗组分层分析显示,新辅助化疗后,有反应组体重从(60.5±9.1)kg升高至(61.3±8.6)kg(t=-2.473,P=0.018),体重指数(BMI)从21.8±2.4升高至22.2±2.0(t=-3.313,P=0.002);无反应组体重和BMI的变化差异均无统计学意义(P均>0.05)。两组骨骼肌、无机盐、细胞外液、体脂肪、蛋白质、上臂周长和细胞内液在治疗前、后的水平差异均无统计学意义(P均>0.05)。有反应组和无反应组化疗前后营养学指标差异均无统计学意义(P均>0.05)。结论 SOX方案新辅助化疗期间病人营养状况无明显变化,未加重营养不良的状况,且不增加手术危险性及围手术期并发症的发生率。

Objective To investigate the effect of neoadjuvant chemotherapy with oxaliplatin ＋ S-1（SOX） regimens on the perioperative period of patients with advanced stage Ⅲ gastric cancer. Methods The clinical pathology data of 161 patients with advanced stage Ⅲ gastric cancer who were treated at the Department of Surgical Oncology, Weifang People’s Hospital of from January 2013 to January 2017 were retrospectively analyzed. The patients were divided into neoadjuvant chemotherapy group （75 cases） and traditional treatment group （86 cases）.The perioperative changes in the two groups of patients were compared. The nutritional status of the patients before and after chemotherapy in the response group and non-response group was compared in further analysis. Results There was no significant difference in gender, age, pathogenesis, pathological type, preoperative staging and surgical methods between neoadjuvant chemotherapy group and traditional treatmentr goup （all P〉0.05）. There were no significant differences in the time of operation, intraoperative blood loss, postoperative venting time, postoperative recovery time, incision suture removal time, postoperative hospital stay, and incidence of postoperative complications （P〉0.05）. Analysis of neoadjuvant chemotherapy component layers showed that after neoadjuvant chemotherapy, in response group, body weight rose from （60.5±9.1） kg to （61.3±8.6） kg （t=-2.473, P=0.018）, and body mass index （BMI） from 21.8±2.4 to 22.2±2.0 （t=-3.313, P=0.002）; there was no significant difference in body weight and BMI in the non-response group （all P〉0.05）. There was no significant difference in the levels of skeletal muscle, inorganic salt, extracellular fluid, body fat, protein, upper arm circumference, and intracellular fluid before and after treatment （P〉0.05）. There was no significant difference in nutritional indicators before and after chemotherapy between the response group and the non-response group （P〉0.05）. Conclusion During the period of neoadjuvant chemotherapy in the SOX regimen, there is no significant change in the nutritional status of the patients, which do not aggravate malnutrition, and do not increase the risk of surgery or the incidence of perioperative complications.