DOF方案与XELOX方案一线治疗进展期胃癌疗效对比

Comparison of DOF regimen and XELOX regimen as first-line treatment in advanced gastric cancer patients

目的对比分析多西他赛、奥沙利铂联合氟尿嘧啶(DOF)方案和卡培他滨联合奥沙利铂(XELOX)方案在进展期胃癌(AGC)患者化疗中的临床疗效和安全性。方法回顾性分析2015-03-01-2017-12-01南华大学附属南华医院肿瘤科收治的初治AGC患者72例,分为DOF组(35例)和XELOX组(37例)。Kaplan-Meier法分析评价化疗疾病控制率(DCR)、中位疾病进展时间(mPFS)、中位总生存期(mOS)和化疗相关不良反应。多因素Cox回归分析影响PFS、OS的相关因素。结果DOF组和XELOX组的DCR分别为85.7%和59.5%(χ^(2)=6.180,P=0.018),mPFS分别为7.6和5.2个月(χ^(2)=27.46,P<0.001),mOS分别为14.6和10.6个月(χ^(2)=22.74,P<0.001)。多因素分析发现,患者PS评分(OR=9.069,95%CI为3.599~22.852)、化疗反应率(OR=0.143,95%CI为0.057~0.359)、肿瘤分期(OR=3.146,95%CI为1.477~6.701)和接受化疗方案(OR=5.401,95%CI为2.310~12.625)是影响PFS的预后因素。影响OS的预后因素也与患者PS评分(OR=6.598,95%CI为2.898~15.023)、化疗反应率(OR=0.278,95%CI为0.123~0.632)、肿瘤分期(OR=5.097,95%CI为2.115~12.282)和接受化疗方案(OR=6.068,95%CI为2.635~13.977)相关。DOF组的3~4级不良反应以中性粒细胞减少和周围神经毒性为主,XELOX组以手足综合征为主。结论DOF方案在一线治疗AGC中疗效较XELOX更高,有PFS、OS的获益,2组不良反应谱不同,但均可耐受。体力状况较差与合并较多基础疾病的患者需谨慎选择DOF方案。

Objective To assess the safety and efficacy of Docetaxel,oxaliplatin and fluorouracil(DOF)versus capecitabine combined with oxaliplatin(XELOX)regimens in patients with advanced gastric cancer(AGC).Methods Retrospectively assesses patients with untreated AGC in the the Nanhua Affiliated Hospital of Nanhua University from March 1,2015 to December 1,2017.A total of 72 patients respectively underwent DOF(n=35)regimen and XELOX(n=37)regimen.All patients received at least 2 cycles of chemotherapy.Kaplan-Meier curve was used to estimate disease control rate,median progression-free survival,median overall survival and Cox-regression for multivariate analysis.Results The DCR in DOF group and XELOX group were 85.7%and 59.5%respectively(χ^(2)=6.180,P=0.018).The median PFS and OS in DOF group were significantly better than XELOX group(7.6 months vs 5.2 months,χ^(2)=27.46,P<0.001;14.6 months vs 10.6 months,χ^(2)=22.74,P<0.001).The multivariate Cox-regression analysis for PFS showed that PS(Performance Status)scores(OR=9.069,95%CI:3.599-22.852),response(OR=0.143,95%CI:0.057-0.359),stage(OR=3.146,95%CI:1.477-6.701)and regimen(OR=5.401,95%CI:2.310-12.625)were independent prognostic factors for PFS,as well as that PS scores(OR=6.598,95%CI:2.898-15.023),response(OR=0.278,95%CI:0.123-0.632),stage(OR=5.097,95%CI:2.115-12.282)and regimen(OR=6.068,95%CI:2.635-13.977)for OS.The most commonGrade 3-4 toxicities in DOF group were neutropenia and peripheral neuropathy.The most common Grade 3-4 toxicity in XELOX was hand-foot syndrome.Conclusions The efficacy of DOF regimen is superior to XELOX regimen as first-line treatment for AGC in terms of DCR,DFS and OS.The toxicities are different between the two groups yet tolerable.DOF regimen should be chosen carefully in view of the patient’s general condition and basic disease.