Ⅲ期胃癌术后辅助免疫化疗的疗效观察

Effect of postoperative adjuvant immunochemotherapy for stage III gastric cancer

目的 探讨云芝多糖(PSK)+丝裂霉素(MMC)+氟脲嘧啶(FT-207)免疫化疗方案对Ⅲ期胃癌患者的术后辅助治疗效果。方法 将126例治愈根治性切除的Ⅲ期胃癌病例,术后随机分为两组:对照组(66例)术后辅助MMC+FT-207方案化疗,试验组(60例)术后辅助PSK+MMC+FT-207方案免疫化疗。分别观察患者一般状态、骨髓抑制、肝功能、T细胞亚群及生存率情况。结果 (1)治疗组全身乏力、面色苍白、食少纳差、恶心呕吐、腹胀、腹泻等症状明显好于对照组(P<0.05),同时治疗组化疗后外周血中白细胞减少及血小板减少均少于对照组,尤其是2级以上的的骨髓抑制也少于对照组。(2)化疗后对照组免疫功能略有下降,但试验组T细胞亚群不下降,反而略升高。同时对照组的丙氨酸转氨酶(ALT)和天冬氨酸转氨酶(AST)升高、总蛋白及白蛋白降低均较试验组高,说明PSK具有保护药物对肝的损伤作用。(3)试验组与对照组3年生存率分别为51.7％(31/60)和53.0％(35/66),差别不大。但前者5年生存率为46.7％(28/60),显著高于后者31.8％(21/66,P<0.05)。结论MMC+FT-207+PSK免疫化疗可提高胃癌患者对化疗的耐受性、改善生活质量及延长生存时间。

Objective This study was designed to investigate the effect of postoperative adjuvant immuno-chemotherapy with Mitomycin C (MMC) + Tegaful (FT-207) + PSK regimen in stage III gastric cancer.Methods One hundred and twenty-six patients with gastric cancer, who received curative A gastrectomy, were randomized into two groups after operation, which including immunochemotherapy group (n = 60) with MMC + FT-207 + PSK regimen, and chemotherapy group ( n = 66) with MMC + FT-207 regimen.The general performance status, bone marrow suppression, hepatic function, T lymphocyte subpopulation and postoperative survival rate were observed. Results (1) The performance status,such as tiredness,paleness,loss of appetite, vomiting and nausea,flatulence and diarrhea , of the patients in immunochemotherapy groups were less than that of the patients in chemotherapy group( P < 0.05) ,and the occurrence and severity of leukopenia and thrombocytopenia in immunochemotherapy groups were also less than that in chemotherapy group( P < 0.05) , especially grade 2 or more severe bone marrow suppression. (2)The T lymphocyte subpopulation in contrast group was decreased after receiving chemotherapy, whereas the T lymphocyte subpopulation was little elevated in immunochemotherapy group compared with that before receiving chemotherapy. Meanwhile, the elevation of alanine aminotransferase and aspartate aminotransferase, and decrease of total protein and albumin in chemotherapy groups was much severer than those in immunochemotherapy group, this implied that PSK had protective function of liver injury of chemotherapy drugs. (3) There was no difference of 3- year survival rate between immunochemotherapy group (51. 7% ,31/60) and chemotherapy group(53. 0% , 35/ 66) ,but the 5-year survival rate (46.7% ,28/60) of immunochemotherapy group was better than that (31.8% ,21/ 66) of chemotherapy patients (P < 0.05). Conclusion Immunochemotherapy with PSK + MMC + FT-207 regimen might enhance the patient for chemotherapy and effects, and improve quality of life and survival time.