CAJ | 학술논문

目的探讨按“肿瘤血管正常化窗口(NWTV)”假设对不能切除的胃癌患者进行新辅助治疗的合理性.方法前瞻性收集2010年10月至2011年3月间武汉大学人民医院收治的进展期及局部晚期不能切除的93例胃癌患者,按随机数字表法分为A组[30例,采用FOLFOX4(奥沙利铂、四氢叶酸和氟尿嘧啶)常规新辅助化疗]、B组(29例,前述方案加贝伐单抗靶向治疗)和C组(34例,按NWTV假设,按B组方案进行新辅助化疗,贝伐单抗用药5d后按A组方案治疗).比较3组新辅助治疗的疗效、不良反应及临床结局.结果 3组患者一般资料的差异无统计学意义(P＞0.05).所有患者均按计划完成了新辅助化疗,新辅助化疗疗效和不良反应3组间的差异均无统计学意义(均P＞0.05).3组新辅助化疗后肿瘤分期下降率分别为56.7％ (17/30)、72.4％( 21/29)和85.3％(29/34),C组明显高于A组(P＜0.05)；R0切除率分别为23.3％(7/30)、27.6％(8/29)和52.9％(18/34),C组明显高于A组和B组(均P＜O.05).3组患者均未出现围手术期死亡病例,术后并发症发生率的差异亦无统计学意义(P＞0.05).结论抗血管生成剂应用于胃癌的新辅助治疗中能改善临床疗效,按NWTV窗口指导的给药方式效果更佳.
목적 탐토안“종류혈관정상화창구(NWTV)”가설대불능절제적위암환자진행신보조치료적합이성.방법 전첨성수집2010년10월지2011년3월간무한대학인민의원수치적진전기급국부만기불능절제적93례위암환자,안수궤수자표법분위A조[30례,채용FOLFOX4(오사리박、사경협산화불뇨밀정)상규신보조화료]、B조(29례,전술방안가패벌단항파향치료)화C조(34례,안NWTV가설,안B조방안진행신보조화료,패벌단항용약5d후안A조방안치료).비교3조신보조치료적료효、불량반응급림상결국.결과 3조환자일반자료적차이무통계학의의(P＞0.05).소유환자균안계화완성료신보조화료,신보조화료료효화불량반응3조간적차이균무통계학의의(균P＞0.05).3조신보조화료후종류분기하강솔분별위56.7％ (17/30)、72.4％( 21/29)화85.3％(29/34),C조명현고우A조(P＜0.05)；R0절제솔분별위23.3％(7/30)、27.6％(8/29)화52.9％(18/34),C조명현고우A조화B조(균P＜O.05).3조환자균미출현위수술기사망병례,술후병발증발생솔적차이역무통계학의의(P＞0.05).결론 항혈관생성제응용우위암적신보조치료중능개선림상료효,안NWTV창구지도적급약방식효과경가.
Objective To evaluate the value of normalization window of tumor vasculature (NWTV) in patients with unresectable gastric cancer undergoing neoadjuvant chemotherapy.Methods From October 2010 to March 2011,93 patients with unresectable advanced or locally advanced gastric carcinoma were prospectively collected and randomly divided to Group A(n=30),Group B (n=29),and Group C (n=34).Group A received FOLFOX4 as conventional neoadjuvant chemotherapy.Group B received FOLFOX4 plus bevacizumab.The treatment was adjusted in Group C according to the hypothesis of NWTV with neoadjuvant chemotherapy delivered 5 days after bevacizumab treatment.The efficacy, drug toxicity and clinical outcome were assessed and compared between the three groups.Results There were no significant differences among the 3 groups in demographics (P＞0.05).All the patients completed the neoadjuvant chemotherapy.Efficacy and toxicity between the three groups were comparable (P＞0.05).The rates of tumor downstaging in the three groups were 56.7％(17/30),72.4％ (21/29),85.3％ (29/34),respectively,with a significantly lower downstaging rate in Group C as compared to Group A (P＜0.05).R0 resection rates were 23.3％(7/30),27.6％(8/29),52.9％ (18/34),respectively, with significantly higher R0 resection rate in Group C as compared to Group A and Group B (All P＜0.05).There was no perioperative death in this cohort.Postoperative complications were comparable among the 3 groups (P＞0.05).Conclusions Anti-angiogenesis agent can improve the efficacy of neoadjuvant chemotherapy in unresectable gastric cancer.Furthermore,administration according to NWTV may achieve better outcomes.