顺铂、奥沙利铂或奈达铂在Ⅲ期食管癌新辅助化疗疗效中的对比研究

Comparative study of neoadjuvant chemotherapy for cisplatin,oxaliplatin or nedaplatin in stageⅢesophageal cancer

目的:比较顺铂、奥沙利铂、奈达铂在Ⅲ期食管癌新辅助化疗疗效和安全性的差异。方法:前瞻性纳入2014年1月至2018年1月期间上海交通大学医学院附属苏州九龙医院170例符合纳入标准的Ⅲ期食管癌新辅助化疗患者,所有患者均接受手术治疗,分析其疗效及不良反应发生情况。新辅助化疗方案为紫杉醇联合顺铂(n=55)、奥沙利铂(n=57)或奈达铂(n=58),每3周为1周期,共行2周期新辅助化疗。结果:所有患者中,新辅助化疗后获CR 7例、PR 101例、SD 58例、PD 4例,客观有效率为63.5%,三组间总生存期无统计学差异(P=0.278)。主要不良反应包括骨髓抑制、肝功能损伤、肾功能损伤、呕吐、腹泻,其中Ⅲ/Ⅳ级不良反应发生率为5.9%(10/170)。组间比较显示,奈达铂和奥沙利铂有效率与顺铂相当,但肌酐升高、呕吐发生率显著低于顺铂,而奥沙利铂腹泻发生率明显高于其他2组。结论:奈达铂和奥沙利铂在Ⅲ期食管癌新辅助化疗中疗效不低于顺铂,但不良反应率明显下降。

Objective:To compare the efficacy and safety of neoadjuvant chemotherapy for cisplatin,oxaliplatin and nedaplatin in stageⅢesophageal cancer.Methods:A prospective enrollment of 170 patients with neoadjuvant chemotherapy for stageⅢesophageal cancer who met the inclusion criteria during the period from January 2014 to January 2018 in Suzhou Kowloon Hospital Affiliated to Shanghai Jiaotong University School of Medicine was performed.All patients underwent surgery to analyze their efficacy and dysfunction.The reaction occurred.The neoadjuvant chemotherapy regimen was paclitaxel plus cisplatin(n=55),oxaliplatin(n=57)or nedaplatin(n=58),one cycle every 3 weeks,a total of 2 cycles of neoadjuvant chemotherapy.Results:Among all patients,7 patients received CR,101 patients with PR,58 patients with SD,and 4 patients with PD.The objective effective rate was 63.5%.There was no significant difference in the overall survival between the three groups(P=0.462).Adverse reactions included myelosuppression,liver damage,renal impairment,vomiting,and diarrhea.The incidence of gradeⅢ-Ⅳadverse reactions was 5.9%(10/170).Comparison between groups showed that nedaplatin and oxaliplatin were as effective as cisplatin,but the incidence of creatinine and vomiting was significantly lower than that of cisplatin,and the incidence of oxaliplatin diarrhea was significantly higher than the other two groups.Conclusion:Nidaplatin and oxaliplatin are not inferior to cisplatin in neoadjuvant chemotherapy for stageⅢesophageal cancer,but the adverse reaction rate is significantly reduced.