术前SOX方案新辅助化疗对局部进展期胃癌手术效果的影响

Effect of preoperative SOX regimen as neoadjuvant chemotherapy on surgery effect of locally advanced gastric cancer

目的探讨术前替吉奥联合奥沙利铂(SOX)方案新辅助化疗对局部进展期胃癌患者手术效果的影响。方法将2011年1月至2012年12月我院普外科收治的82例局部进展期胃癌患者,按照随机数字表法分为两组,每组各41例。观察组术前行SOX方案辅助化疗,对照组术后行SOX方案辅助化疗。观察观察组患者的近期疗效和不良反应,比较两组患者切缘无癌细胞(R0)切除率、根治手术(D2)完成率、联合脏器切除率、术后并发症发生情况,随访1~3年,统计两组患者的生存率。结果观察组患者的客观缓解率、疾病控制率、临床降期率分别为43.90%(18/41)、95.12%(39/41)、48.78%(20/41);术前化疗毒副作用主要表现为轻度血液毒性反应和胃肠道反应;观察组患者的R0切除率和D2完成率分别为90.24%(37/41)和100.00%(41/41),均高于对照组的73.17%(30/41)和80.49%(33/41),差异均有统计学意义(P<0.05);两组患者的联合脏器切除率和手术并发症发生率比较差异均无统计学意义(P>0.05);观察组术后1年生存率为87.80%,略高于对照组的82.93%,但差异无统计学意义(P>0.05)。结论术前给予局部进展期胃癌患者SOX新辅助化疗可提高根治手术切除率,毒副反应小,不增加手术风险,值得临床推广应用。

Objective To explore the effect of preoperative S-1 combined with oxaliplatin(SOX) regimen as neoadjuvant chemotherapy on surgery effect of locally advanced gastric cancer. Methods Eighty-two patients with locally advanced gastric cancer in Department of General Surgery in our hospital from January 2011 to December 2012 were randomly divided into two groups(observation group and control group) according to the random number table,with 41 patients in each group. The observation group received preoperative SOX chemotherapy, and the control group received SOX chemotherapy after surgery. The short-term efficacy and adverse reactions of the observation group were observed. The non-cancerous cell(R0) resection rate, radical operation(D2) completion rate, combined organ resection rate, and the incidence of postoperative complications were compared between the two groups. The patients were followed up for 1~3 years, and the survival rate of the two groups were statistically analyzed. Results The objective remission rate, disease control rate and clinical down-staging rate of observation group were 43.90%(18/41), 95.12%(39/41),48.78%(20/41), respectively. The side effects of preoperative chemotherapy mainly manifested as mild hematologic toxicity reaction and gastrointestinal reaction. The R0 resection rate and D2 completion rate of observation group were respectively 90.24%(37/41) and 100.00%(41/41), which were significantly higher than those of the control group of 73.17%(30/41) and 80.49%(33/41), and the differences were statistically significant(P<0.05). There were no significant difference in combined organ resection rate and incidence of postoperative complications between the two groups(P>0.05).The 1-year survival rate after surgery was 87.80%(36/41) in observation group, which was slightly higher than that in control group of 82.93%(34/41), but the difference was not statistically significant(P>0.05). Conclusion Preoperative SOX regimen as neoadjuvant chemotherapy for patients with locally advanced gastric cancer can improve the rate of radical resection while not increasing the risk of surgery, with less toxic side effects. It is worthy of clinical popularization and application.