XELOX联合曲妥珠单抗在HER2阳性老年晚期胃癌转化治疗中的疗效观察

Effect of XELOX combined with trastuzumab in the treatment of HER2 positive elderly patients with advanced gastric cancer

目的评价卡培他滨联合奥沙利铂即XELOX化疗方案联合曲妥珠单抗在人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)阳性老年晚期胃癌转化治疗中的初步疗效及安全性。方法回顾性分析2019年2月至2021年2月期间就诊于中国人民解放军北部战区总医院21例行XELOX联合曲妥珠单抗治疗HER2阳性老年晚期胃癌患者的临床及手术资料,观察患者转化治疗后的缓解情况及术中和术后相关指标。结果21例患者经转化治疗后,完全缓解2例(9.5%),部分缓解13例(61.9%),病情稳定6例(28.6%),缓解率为71.4%(15/21)。转化治疗后21例均行腹腔镜探查术,其中行R0切除20例(95.2%),单纯探查术1例。手术时间为124~185 min、中位数为152 min,术中出血量100~210 mL、中位数120 mL,清扫淋巴结数为12~54枚、中位数为32枚。留置胃肠减压时间为51~134 h,中位数为102 h,恢复胃肠功能时间为70~98 h、中位数为78 h,腹腔术区放置引流的时间为4~9 d、中位数为6 d,术后住院时间为7~13 d、中位数为8 d。术后发生ⅢA级并发症2例(不全性肠梗阻及肺部感染各1例),发生Ⅱ级并发症2例(切口脂肪液化及颈静脉导管感染各1例)。所有患者均获得随访,随访时间为3~36个月、中位数16.8个月,中位无进展生存时间为12.4个月,中位总生存时间为20.5个月。结论对于HER2阳性老年晚期胃癌患者,XELOX联合曲妥珠单抗转化治疗是有效且安全的。

Objective To evaluate the preliminary efficacy and safety of XELOX combined with trastuzumab in the transformation therapy of human epidermal growth factor receptor 2(HER2)positive elderly patients with advanced gastric cancer.Methods The clinical and surgical data of 21 patients with HER2 positive elderly patients with advanced gastric cancer who were treated with XELOX combined with trastuzumab in our Hospital from February 2019 to February2021 were retrospectively analyzed,and the remission of patients after conversion therapy and the relevant indicators during and after surgery were observed.Results After the conversion therapy,there were 2 cases(9.5%)of complete remission,13 cases(61.9%)of partial remission,and 6 cases(28.6%)of stable disease,the remission rate of the conversion therapy was 71.4%(15/21).After conversion treatment,21 patients underwent laparoscopic exploration,of which 20 patients(95.2%)underwent R0 resection,simple exploration 1 case.In all 21 cases,the operative time was124-185 min,with a median of 152 min.The intraoperative blood loss was 100-210 mL,with a median of 120 mL.The number of lymph nodes cleared was 12-54,with a median of 32.The duration of indwelling gastrointestinal decompression was 51-134 h,with a median of 102 h.The recovery time of gastrointestinal function was 70-98 h,with a median of 78 h.The drainage time in the abdominal operation area was 4-9 days,with a median of 6 days.Postoperative hospital stay was 7-13 days,with a median of 8 days.There were 2 cases of Grade ⅢA complications(1 case of incomplete intestinal obstruction and 1 case of pulmonary infection)and 2 cases of Grade Ⅱ complications(1 case of incision fat liquefaction and 1 case of jugular catheter infection)after operation.All patients were followed up for 3-36 months,with a median of 16.8 months.The median progression-free survival time was 12.4 months and the median overall survival time was 20.5 months.Conclusion For HER2 positive elderly patients with advanced gastric cancer,XELOX combined with trastuzumab transformation therapy is effective and safe.