目的 比较XELOX和FOLFOX4两种新辅助化疗方案对不能手术切除的局部进展期胃癌患者的疗效.方法 前瞻性分析2006年7月至2009年10月山东大学附属省立医院收治的72例胃癌患者的临床资料.对由多学科协作小组评定不能手术切除的局部进展期胃癌患者,按照随机数字表法分为XELOX组(36例)和FOLFOX4组(失访3例,最终纳入本研究33例).两组患者分别采用XELOX方案和FOLFOX4方案化疗6周.6周后根据复查结果由多学科协作小组评估疗效,对于完全缓解和部分缓解的患者施行手术切除并采用流式细胞仪检测细胞周期.率的比较采用Pearson x2检验;胃癌细胞周期各指数先采用Levene检验进行方差齐性检验,方差不齐采用t′检验,方差齐采用t检验.结果 XELOX组和FOLFOX4组的有效率分别为53%(19/36)和52%(17/33),两组比较,差异无统计学意义(x2=0.01,P＞0.05).XELOX组和FOLFOX4组中患者恶心呕吐、静脉炎、手足综合征的发生率分别为25%(9/36)、6%(2/36)、19%(7/36)和55%(18/33)、39%(13/33)、3%(1/33),两组比较,差异有统计学意义(x2=6.31,11.59,4.53,P＜0.05).XELOX组化疗有效的19例患者和FOLFOX4组化疗有效的17例患者接受手术切除,术后未发生吻合口漏、大出血等严重并发症.新辅助化疗后,XELOX组胃癌细胞的S期细胞比率(SPF)、增殖指数(PI)、G2/M分别为5.89%±0.79%、9.22%±1.99%、5.19%±1.66%,低于新辅助化疗前的6.76%±1.21%、10.44%±2.12%、6.04%±0.57%,而新辅助化疗后G0/G1为90.39%±4.78%,高于新辅助化疗前的87.54%±6.34%(x2=3.61,2.52,2.15,2.91,P＜0.05);FOLFOX4组新辅助化疗后的SPF、PI、G2/M分别为6.09%±0.96%、10.65%±2.47%、4.88%±0.87%,低于新辅助化疗前的7.15%±1.45%、11.87%±2.33%、5.67%±1.03%,而新辅助化疗后G0/G1为91.45%±5.22%,高于新辅助化疗前的88.01%±4.23%(x2=3.50,2.06,3.37,2.94,P＜0.05).新辅助化疗后两组PI值比较,差异有统计学意义(x2=2.66,P＜0.05).结论 XELOX和FOLFOX4两种新辅助化疗方案对不能手术切除的局部进展期胃癌患者安全、有效,对胃癌细胞的增殖抑制明显;XELOX方案比FOLFOX4方案更为有效.
目的 比較XELOX和FOLFOX4兩種新輔助化療方案對不能手術切除的跼部進展期胃癌患者的療效.方法 前瞻性分析2006年7月至2009年10月山東大學附屬省立醫院收治的72例胃癌患者的臨床資料.對由多學科協作小組評定不能手術切除的跼部進展期胃癌患者,按照隨機數字錶法分為XELOX組(36例)和FOLFOX4組(失訪3例,最終納入本研究33例).兩組患者分彆採用XELOX方案和FOLFOX4方案化療6週.6週後根據複查結果由多學科協作小組評估療效,對于完全緩解和部分緩解的患者施行手術切除併採用流式細胞儀檢測細胞週期.率的比較採用Pearson x2檢驗;胃癌細胞週期各指數先採用Levene檢驗進行方差齊性檢驗,方差不齊採用t′檢驗,方差齊採用t檢驗.結果 XELOX組和FOLFOX4組的有效率分彆為53%(19/36)和52%(17/33),兩組比較,差異無統計學意義(x2=0.01,P＞0.05).XELOX組和FOLFOX4組中患者噁心嘔吐、靜脈炎、手足綜閤徵的髮生率分彆為25%(9/36)、6%(2/36)、19%(7/36)和55%(18/33)、39%(13/33)、3%(1/33),兩組比較,差異有統計學意義(x2=6.31,11.59,4.53,P＜0.05).XELOX組化療有效的19例患者和FOLFOX4組化療有效的17例患者接受手術切除,術後未髮生吻閤口漏、大齣血等嚴重併髮癥.新輔助化療後,XELOX組胃癌細胞的S期細胞比率(SPF)、增殖指數(PI)、G2/M分彆為5.89%±0.79%、9.22%±1.99%、5.19%±1.66%,低于新輔助化療前的6.76%±1.21%、10.44%±2.12%、6.04%±0.57%,而新輔助化療後G0/G1為90.39%±4.78%,高于新輔助化療前的87.54%±6.34%(x2=3.61,2.52,2.15,2.91,P＜0.05);FOLFOX4組新輔助化療後的SPF、PI、G2/M分彆為6.09%±0.96%、10.65%±2.47%、4.88%±0.87%,低于新輔助化療前的7.15%±1.45%、11.87%±2.33%、5.67%±1.03%,而新輔助化療後G0/G1為91.45%±5.22%,高于新輔助化療前的88.01%±4.23%(x2=3.50,2.06,3.37,2.94,P＜0.05).新輔助化療後兩組PI值比較,差異有統計學意義(x2=2.66,P＜0.05).結論 XELOX和FOLFOX4兩種新輔助化療方案對不能手術切除的跼部進展期胃癌患者安全、有效,對胃癌細胞的增殖抑製明顯;XELOX方案比FOLFOX4方案更為有效.
목적 비교XELOX화FOLFOX4량충신보조화료방안대불능수술절제적국부진전기위암환자적료효.방법 전첨성분석2006년7월지2009년10월산동대학부속성립의원수치적72례위암환자적림상자료.대유다학과협작소조평정불능수술절제적국부진전기위암환자,안조수궤수자표법분위XELOX조(36례)화FOLFOX4조(실방3례,최종납입본연구33례).량조환자분별채용XELOX방안화FOLFOX4방안화료6주.6주후근거복사결과유다학과협작소조평고료효,대우완전완해화부분완해적환자시행수술절제병채용류식세포의검측세포주기.솔적비교채용Pearson x2검험;위암세포주기각지수선채용Levene검험진행방차제성검험,방차불제채용t′검험,방차제채용t검험.결과 XELOX조화FOLFOX4조적유효솔분별위53%(19/36)화52%(17/33),량조비교,차이무통계학의의(x2=0.01,P＞0.05).XELOX조화FOLFOX4조중환자악심구토、정맥염、수족종합정적발생솔분별위25%(9/36)、6%(2/36)、19%(7/36)화55%(18/33)、39%(13/33)、3%(1/33),량조비교,차이유통계학의의(x2=6.31,11.59,4.53,P＜0.05).XELOX조화료유효적19례환자화FOLFOX4조화료유효적17례환자접수수술절제,술후미발생문합구루、대출혈등엄중병발증.신보조화료후,XELOX조위암세포적S기세포비솔(SPF)、증식지수(PI)、G2/M분별위5.89%±0.79%、9.22%±1.99%、5.19%±1.66%,저우신보조화료전적6.76%±1.21%、10.44%±2.12%、6.04%±0.57%,이신보조화료후G0/G1위90.39%±4.78%,고우신보조화료전적87.54%±6.34%(x2=3.61,2.52,2.15,2.91,P＜0.05);FOLFOX4조신보조화료후적SPF、PI、G2/M분별위6.09%±0.96%、10.65%±2.47%、4.88%±0.87%,저우신보조화료전적7.15%±1.45%、11.87%±2.33%、5.67%±1.03%,이신보조화료후G0/G1위91.45%±5.22%,고우신보조화료전적88.01%±4.23%(x2=3.50,2.06,3.37,2.94,P＜0.05).신보조화료후량조PI치비교,차이유통계학의의(x2=2.66,P＜0.05).결론 XELOX화FOLFOX4량충신보조화료방안대불능수술절제적국부진전기위암환자안전、유효,대위암세포적증식억제명현;XELOX방안비FOLFOX4방안경위유효.
Objective To compare the efficacy of XELOX and FOLFOX4 in the treatment of locally advanced unresectable gastric cancer. Methods The clinical data of 72 patients with gastric cancer who were admitted to the Shandong Provincial Hospital from July 2006 to October 2009 were prospectively analyzed. Of all the patients, 3 lost follow-up, and 69 patients with locally advanced unresectable gastric cancer were randomly divided into XELOX group ( n = 36 ) and FOLFOX4 group ( n = 33 ) according to the random number table.All patients received chemotherapy for six weeks. The efficacy of the two regimens were evaluated by the multidiscipline team six weeks later. The cell cycle of patients with complete or partial remission and received surgical treatment was detected by flow cytometry. All data were analyzed using the Pearson chi-square test, Levene test or t test. Results The curative rates of XELOX and FOLFOX4 were 53% (19/36) and 52% (17/33), respectively,with no significant difference between the two groups ( x2= 0. 01 , P ＞ 0. 05 ). The incidences of nausea and vomiting, phlebitis and hand-foot syndrome were 25% (9/36), 6% (2/36) and 19% (7/36) in the xELOX group, and 55% ( 18/33), 39% (13/33) and 3% (1/33) in the FOLFOX4 group, respectively, with significant difference between the two groups ( x2 = 6.31, 11.59, 4.53, P ＜ 0.05 ). Nineteen patients in the XELOX group and 17 patients in the FOLFOX4 group received surgical resection of the gastric cancer, and no complications such as anastomotic leakage and hemorrhage occurred postoperatively. In the XELOX group, the s-phase fraction (SPF),proliferation index (PI) and G2/M of the gastric cancer cells were 5.89% ± 0.79%, 9.22% ± 1.99% and 5.19% ± 1. 66% after neoadjuvant chemotherapy, which were significantly lower than 6.76% ± 1.21%, 10.44% ±2.12% and 6. 04% ± 0. 57% before neoadjuvant chemotherapy, while the ratio of gastric cancer cells in the G0/G1 phase after neoadjuvant chemotherapy was 90.39% ±4.78%, which was significantly higher than 87.54%±6.34% before neoadjuvant chemotherapy (x2 =3.61, 2.52, 2. 15, 2.91, P ＜0.05). In the FOLFOX4group, the SPF, PI and G2/M of the gastric cancer cells were 6.09% ± 0.96%, 10.65 % ± 2.47% and 4.88% ±0.87% after neoadjuvant chemotherapy, which were significantly lower than 7.15% ± 1.45%, 11.87% ± 2.33%and 5.67% ± 1.03% before neoadjuvant chemotherapy, while the ratio of gastric cancer cells in the G0/G1 phase after neoadjuvant chemotherapy was 91.45% ± 5.22%, which was significantly higher than 88.01% ± 4.23%before neoadjuvant chemotherapy ( x2 = 3.50, 2.06, 3.37, 2.94, P ＜ 0.05 ). There was a significant difference in PI between XELOX group and FOLFOX4 group after neoadjuvant chemotherapy ( x2 = 2.66, P ＜ 0.05 ).Conclusions XELOX and FOLFOX4 are safe and effective in the treatment of locally advanced unresectable gastric cancer, and they can significantly restrain the proliferation of gastric cancer cells. XELOX regimen is more effective than FOLFOX4 regimen.
