紫杉醇脂质体联合卡培他滨与DCF方案治疗晚期胃癌近期疗效比较

Comparison between paclitaxel liposome combined with capecitabine and DCF regimen in the treatment of advanced gastric cancer

目的胃癌发病具有隐匿性,确诊时已属中晚期,失去手术机会,化疗是治疗胃癌的重要方法之一。本研究探讨紫杉醇脂质体联合卡培他滨方案与DCF方案(多西他赛、顺铂和氟尿嘧啶)治疗晚期胃癌的临床疗效及不良反应。方法选取2014-08-01-2016-03-01北部战区总医院肿瘤科收治的晚期胃癌患者66例,其中接受紫杉醇脂质体联合卡培他滨方案治疗的患者为试验组(紫杉醇脂质体150 mg/m^2,静脉滴入d1;卡培他滨1000 mg/m^2,口服d1~d14)33例;接受DCF方案治疗的患者为对照组(多西他赛60 mg/m^2,静脉滴入d1;顺铂60 mg/m^2,静脉滴入d1;氟尿嘧啶500 mg/m^2,静脉滴入d1~d5)33例。每2个周期治疗结束后评价疗效,完成6个周期、出现肿瘤进展和无法耐受化疗相关不良反应时停止治疗。观察疗效及不良反应。结果 66例患者均完成随访。2组患者在完全缓解(complete response,CR)、部分缓解(partial response, PR)、疾病稳定(stable disease, SD)、疾病进展(progressive disease, PD)、总有效率(overall response rate,ORR)及疾病控制率(disease control rate,DCR)的差异无统计学意义,P>0.05。2组患者在肝转移、肺转移、腹膜后淋巴结转移及恶性胸腹水亚组中,ORR差异均无统计学意义,P>0.05。试验组和对照组分别有13例和22例患者下调化疗剂量,χ^2=4.927,P=0.026;试验组17例和对照组26例患者延迟化疗周期(χ^2=5.405,P=0.020),差异有统计学意义。试验组中停止化疗的例数略少于对照组,但差异无统计学意义,P>0.05。试验组与对照组的脱发(6.1% vs 51.5%;χ^2=1.629,P<0.001)、恶心呕吐(63.6% vs 84.8%;χ^2=4.889, P=0.027)、白细胞减少(45.5% vs 78.8%;χ^2=7.791,P=0.005)、肾功异常(3.0% vs 18.2%;χ^2=3.995 ,P=0.046)及过敏(3.0% vs 27.3%;χ^2=7.543,P=0.006)不良反应发生率差异均有统计学意义。结论紫杉醇脂质体联合卡培他滨方案治疗晚期胃癌有较高的有效率,不良反应可耐受,患者生活质量高,值得进一步研究。

OBJECTIVE Gastric cancer is one of the most common malignant tumors in China. Chemotherapy is one of the most important methods for the treatment of gastric cancer for its hidden incidence. This study ained to explore the clinical efficacy and side effects of paclitaxel liposome combined with capecitabine and DCF regimen in the treatment of advanced gastric cancer. METHODS Sixty-six cases of patients with advanced gastric cancer were choosed who were treated between August 1st 2014 and 1st March 2016 in General Hospital of Nothern Theater Command,and were randomly divided into observation group (DCF regimen) and experimental group ( paclitaxel liposome combined with capecitabine).Effect and chemotherapy related adverse reactions were observed through evaluation of curative effect every 2 cycles till the completion of 6 cycles or tumor progression or intolerance of chemotherapy related adverse reactions. RESULTS All patients were followed up. There was no significant difference between the two groups on complete response, partial response, stable disease,progressive disease,overall response rate and disease control rate (all P>0. 05). There was no significant difference between the two groups on subgroups of liver metastasis, lung metastasis, retroperitoneal lymph node metastasis and malignant hydrothorax and ascites (all P〉0. 05). Respectively, 13 patients in the experimental group and 22 patients in the observation group decreased the dose of chemotherapy;17 patients in the experimental group and 26 patients in the observation group delayed chemotherapy cycle, with significant difference between the two groups (χ^2= 4. 927, P = 0. 026;χ^2=5. 405 ,P = 0. 020). There was no significant difference between the two groups on stopping chemotherapy but the number of cases in the experimental group was slightly less than that in the observation group. There was significant difference between the two groups on incidence of alopecia(6. 1% vs 51. 5%), nausea and vomiting(63. 6% vs 84. 8%),leukopenia(45. 5% es 78.8%),renal dysfunction(3. 0% vs 18. 2%) and allergies(3. 0% vs 27. 3%). CONCLUSION Further study could be taken in the regimen of paclitaxel liposome combined capecitabine which had effectivity and tolerable side effects in the treatment of advanced gastric cancer.