SOX新辅助化疗在进展期胃癌的治疗体会

Experience in the treatment of SOX neoadjuvant chemotherapy in advanced gastric cancer

目的观察奥沙利铂联合替吉奥(SOX方案)新辅助化疗对进展期胃癌手术切除率及临床疗效的影响。方法选取青海省人民医院和南方医科大学附属花都医院2016年5月~2019年7月收治的40例无远处转移的进展期胃癌患者,根据治疗方法的不同分为化疗组(n=20)与非化疗组(n=20),两组都给予常规手术治疗,化疗组在此基础上给予SOX方案化疗。观察如下指标:化疗组比较化疗前后胃壁、局部淋巴结、门静脉癌栓影像学表现;术中比较两组之间幽门不全梗阻、胃壁组织水肿情况及肿瘤与周围组织的粘连情况;术后比较两组手术切除率、术中出血量、淋巴结转移、平均住院日、R0切除情况及术后肿瘤TNM分期情况。结果化疗组化疗后胃壁变薄,肿瘤缩小,周围肿大淋巴结减少缩小,门静脉癌栓明显好转;与对照组相比,化疗组术中的幽门不全梗阻、胃壁组织水肿情况、肿瘤与周围组织的粘连情况较非化疗组获得了明显的改善(P<0.05);化疗组的术后切除率高、淋巴结转移少、手术平均住院日短,且提高了R0切除率并降低了术后TNM分期,两组之间差别均具有统计学意义(P<0.05)。结论对于术前评估分期在ⅢA~Ⅵ期无远处转移的进展期胃癌患者,SOX新辅助化疗方案可显著提高根治性手术切除率,且患者耐受性良好。

Objective To observe the effect of neoadjuvant chemotherapy regimen of oxaliplatin combined with S-1(SOX regimen)on resection rate and clinical efficacy in patients with advanced gastric cancer. Methods Fourty cases of advanced gastric cancer cases in the Qinghai Provincial People′s Hospital and Huadu District People′s Hospital of Guangzhou from May 2016 to July 2019 were included. All the cases were divided into chemotherapy group(n=20)and non-chemotherapy group(n=20)accorded to the different treatment methods. Both groups were given conventional surgery,and the chemotherapy group were given SOX chemotherapy on this basis. Observed the following indicators:The patients in the chemotherapy group were compared the imaging findings of the gastric wall,local lymph node,portal vein tumor thrombus before and after the chemotherapy. the pyloric obstruction,the edema of the gastric wall,adhesion of tumor and surrounding tissue were compared intraoperative and surgical resection rate,intraoperative blood loss,lymph node metastasis,average hospital stay were compared postoperative.Moerover,R0 resection and postoperative TNM staging were compared between the two groups. Results Compared with the non-chemotherapy group group,in the chemotherapy group,the gastric wall thin,the tumor shrinkaged,the enlargement of the lymph nodes reduced and disappeared and the portal vein tumor thrombus significantly improved after chemotherapy. The pyloric obstruction and gastric wall edema significantly improved in chemotherapy group(P<0.05). There were no significant difference in the age,gender and intraoperative blood loss between the two groups(P>0.05). Surgical resection rate,lymph node metastasis and average hospital stay have difference between the two groups(P<0.05). The neoadjuvant chemotherapy with SOX also significantly improved the R0 resection and reduced the postoperative TNM staging(P<0.05). Conclusion Neoadjuvant chemotherapy with SOX can significantly improve the radical resection rate in advanced gastric cancer patients with stage T3 and above,and is well tolerated in patients with advanced gastric cancer,which is worthy of promotion in clinical practice.