整合化疗治疗老年局部晚期胃癌的临床研究

Clinical study of integrated chemotherapy in the treatment of locally advanced gastric cancer in the elderly

目的:研究整合化疗在老年局部晚期胃癌治疗中的作用。方法:选取老年局部晚期胃癌60例,随机分为观察组和对照组,各30例。观察组采用介入治疗+口服替吉奥,介入灌注药物为氟尿嘧啶1.0 g/m2+奥沙利铂130 mg/m2,术后一周口服替吉奥40毫克/次,一日2次,连服4周,休息2周,为一周期,两周期评估治疗情况。对照组采用口服替吉奥,剂量及疗程同观察组,静脉应用奥沙利铂150 mg/m2。比较2组病人近期疗效、不良反应和预后情况。结果:观察组客观反应率、疾病控制率分别为50.0%、83.3%,对照组分别为26.6%、50.0%,2组病人治疗效果差异有统计学意义(P<0.01)。2组病人不良反应多为轻-中度反应,对症处理后均缓解,差异无统计学意义(P>0.05)。观察组中位无进展生存期为17个月,95%CI:16.53~25.28,对照组中位无进展生存期13个月,95%CI:10.98~14.18,观察组生存期较对照组明显延长(P<0.01)。单因素分析显示病人生存情况与肿瘤位置、病期、是否手术、化疗后情况等因素有关(P<0.05~P<0.01),与病人性别、病理类型、大体类型等无明显相关性(P>0.05)。多因素分析显示分组情况是预后的独立影响因素(P<0.01,95%CI=19.89~21.54)。结论:应用整合化疗治疗老年局部晚期胃癌能改善病人预后,安全性较好。

Objective:To explore the integrated chemotherapy in the treatment of locally advanced gastric cancer in the elderly.Methods:Sixty elderly cases with locally advanced gastric cancer were randomly divided into observation group and control group(30 cases in each group).The observation group was treated with interventional therapy of 5-fluorouracil 1.0 g/m2 plus oxaliplatin 130 mg/m2,and oral tegiol 40 mg each time at one week after surgery,bid,for 4 weeks,rest for 2 weeks,which was a cycle.The treatment efficacy was evaluated after two cycles.The control group was treated with oral tegiol following the same dose and course of treatment as the observation group,and oxaliplatin 150 mg/m2 was used intravenously.The short-term efficacy,adverse reactions and prognosis in two groups were compared.Results:The objective response rate and disease control rate in observation group were 50.0%and 83.3%,respectively,which were 26.6%and 50.0%in control group,respectively.There was a significant difference in treatment efficacy between two groups(P<0.01).The adverse reactions in two groups were mostly mild to moderate,and were alleviated after symptomatic treatment,the difference of which was not statistically significant(P>0.05).The median progression-free survival was 17 months,with 95%CI of 16.53 to 25.28 in observation group,which were 13 months and 10.98 to 14.18 in control group,and the survival time in observation group was significantly longer than that in control group(P<0.01).Univariate analysis showed that the survival time of patients was correlated with the location of tumor,duration of disease,surgery or not,and postchemotherapy(P<0.05 to P<0.01),and was not significantly correlated with the gender,pathological type and gross type(P>0.05).Multivariate analysis showed that grouping was an independent prognostic factor(P<0.01,95%CI=19.89-21.54).Conclusions:The application of integrated chemotherapy in treating locally advanced gastric cancer in elderly patients can improve the prognosis with good safety.