CAJ | 학술논문

目的观察新辅助区域动脉化疗对进展期胃癌的临床疗效及毒性反应.方法回顾性分析2000年2月至2005年5月上海交通大学医学院附属仁济医院收治的158例相同临床分期的进展期胃癌患者的临床资料.其中76例(研究组)给予术前区域动脉化疗,方案为表阿霉素50 mg/m2+顺铂60 mg/m2+5-氟尿嘧啶1000 mg/m2,2003年起方案改为奥沙利铂130 mg/m2+5-氟尿嘧啶1000mg/m2,一次性动脉灌注,6～11 d后手术治疗.另82例(对照组)术前未行化疗,直接手术治疗.两组患者术后均接受静脉辅助化疗.对两种治疗方式的临床效果、根治性(R0)切除率、手术并发症和远期预后进行评估.采用x2检验,Kaplan-Meier法行生存分析.结果研究组和对照组的R0切除率分别为86%(65/76)和71%(58/82),两组比较,差异有统计学意义(x2=5.01,P<0.05).研究组的化疗毒副反应轻微.研究组和对照组的术后并发症发生率分别为20%(15/76)和16%(13/82),两组比较,差异无统计学意义(x2=0.41,P＞0.05).研究组和对照组的中位生存时间分别为41个月和23个月,5年总体生存率分别为44.6%和29.1%,两组比较,差异有统计学意义(x2=3.95,P<0.05).结论进展期胃癌患者采用新辅助区域动脉化疗耐受性良好,有助于提高R0切除率,并延长其生存时间.
목적 관찰신보조구역동맥화료대진전기위암적림상료효급독성반응.방법 회고성분석2000년2월지2005년5월상해교통대학의학원부속인제의원수치적158례상동림상분기적진전기위암환자적림상자료.기중76례(연구조)급여술전구역동맥화료,방안위표아매소50 mg/m2+순박60 mg/m2+5-불뇨밀정1000 mg/m2,2003년기방안개위오사리박130 mg/m2+5-불뇨밀정1000mg/m2,일차성동맥관주,6～11 d후수술치료.령82례(대조조)술전미행화료,직접수술치료.량조환자술후균접수정맥보조화료.대량충치료방식적림상효과、근치성(R0)절제솔、수술병발증화원기예후진행평고.채용x2검험,Kaplan-Meier법행생존분석.결과 연구조화대조조적R0절제솔분별위86%(65/76)화71%(58/82),량조비교,차이유통계학의의(x2=5.01,P<0.05).연구조적화료독부반응경미.연구조화대조조적술후병발증발생솔분별위20%(15/76)화16%(13/82),량조비교,차이무통계학의의(x2=0.41,P＞0.05).연구조화대조조적중위생존시간분별위41개월화23개월,5년총체생존솔분별위44.6%화29.1%,량조비교,차이유통계학의의(x2=3.95,P<0.05).결론 진전기위암환자채용신보조구역동맥화료내수성량호,유조우제고R0절제솔,병연장기생존시간.
Objective To investigate the efficacy and toxicity of neoadjuvant regional arterial chemotherapy in the treatment of advanced gastric cancer. Methods The clinical data of 158 patients with advanced gastric cancer and with the same clinical stages who were admitted to Renji Hospital of Shanghai Jiaotong University from February 2002 to May 2005 were retrospectively analysed. Preoperative regional arterial chemotherapy was applied to 76 patients (test group) and the remaining 82 patients only received surgical treatment (control group). The chemotherapy regimen was epirubicin (50 mg/m2) + cisplatin (60 mg/m2) + 5-fluorouracil (1000 mg/m2).This regimen was modified to oxaliplatin (130 mg/m2) + 5-fluorouracil (1000 mg/m2) since 2003, and surgery was performed 6-11 days after the chemotherapy. All patients received postoperative intravenous chemotherapy.The clinical effects, radical resection rate, operative complications and long-term survival of the two treatment methods were evaluated. All data were analysed using the chi-square test and Kaplan-Meier analysis. Results The radical resection rate was significantly higher at 86% (65/76) in the test group compared with 71% (58/82)in the control group ( x2 = 5.01, P ＜ 0. 05 ). The toxicity of the chemotherapy in the test group was mild. The postoperative complication rate was 20% (15/76) in the test group and 16% (13/82) in the control group, with no significant difference between the two groups (x2 = 0.41, P＞0.05). The median survival time was 41 months in the test group and 23 months in the control group. The 5-year overall survival rate was higher in the test group (44.6%) than that in the control group (29.1%) (x2 =3.95, P＜0. 05). Conclusions Neoadjuvant regional arterial chemotherapy is well tolerated by patients with advanced gastric cancer. It is also effective for increasing the radical resection rate and improving the long-term survival.