CAJ | 학술논문

目的：本研究探讨多西他赛联合奥沙利铂±替吉奥用于局部晚期不可切除的老年低分化胃癌患者的安全性及有效性。方法回顾性分析2009年12月至2013年8月期间在本院接受化疗的局部晚期不可切除老年低分化胃癌患者的临床资料，共54例（其中男36例，女18例），中位年龄70.9岁（65～80岁），有55.6%（30/54）的患者年龄调节的Charlson指数＞3。54例患者包括29例接受多西他赛联合奥沙利铂方案化疗以及25例患者在多西他赛联合奥沙利铂方案基础上加用替吉奥，直至疾病进展或不能耐受，每2个周期进行疗效及安全性评价。结果54例患者平均完成4.8个化疗周期，两药化疗组和三药化疗组的客观缓解率（ORR）分别为37.9%、36.0%，临床获益率（CBR）分别为65.5%、72.0%，两组 TTP分别为8.4个月和8.6个月，OS分别为12.9个月和15.3个月，以上数据均无统计学差异（P＞0.05）。Charlson≤3与Charlson＞3的两组患者中位OS分别为15.6个月和12.9个月，Charlson＞3患者中位OS与Charlson≤3患者相比较短，并且有统计学差异（P＝0.013）。54例患者的不良反应均可耐受，主要为骨髓抑制、脱发、胃肠道反应和乏力，大多为Ⅰ～Ⅱ度，Ⅲ～Ⅳ度少见。三药化疗组患者在骨髓抑制、乏力、胃肠道反应方面多于两药化疗组，差异有统计学意义（P＜0.05）。与Charlson≤3患者相比，有更高比例的Charlson＞3者发生Ⅲ或Ⅳ级不良反应。结论对于晚期不可手术切除的低分化老年胃癌患者应给予积极的化疗，延长生存时间，两药联合方案治疗疗效并不差于三药方案，并且不良反应可耐受，更适合老年患者，值得进一步研究。
목적：본연구탐토다서타새연합오사리박±체길오용우국부만기불가절제적노년저분화위암환자적안전성급유효성。방법회고성분석2009년12월지2013년8월기간재본원접수화료적국부만기불가절제노년저분화위암환자적림상자료，공54례（기중남36례，녀18례），중위년령70.9세（65～80세），유55.6%（30/54）적환자년령조절적Charlson지수＞3。54례환자포괄29례접수다서타새연합오사리박방안화료이급25례환자재다서타새연합오사리박방안기출상가용체길오，직지질병진전혹불능내수，매2개주기진행료효급안전성평개。결과54례환자평균완성4.8개화료주기，량약화료조화삼약화료조적객관완해솔（ORR）분별위37.9%、36.0%，림상획익솔（CBR）분별위65.5%、72.0%，량조 TTP분별위8.4개월화8.6개월，OS분별위12.9개월화15.3개월，이상수거균무통계학차이（P＞0.05）。Charlson≤3여Charlson＞3적량조환자중위OS분별위15.6개월화12.9개월，Charlson＞3환자중위OS여Charlson≤3환자상비교단，병차유통계학차이（P＝0.013）。54례환자적불량반응균가내수，주요위골수억제、탈발、위장도반응화핍력，대다위Ⅰ～Ⅱ도，Ⅲ～Ⅳ도소견。삼약화료조환자재골수억제、핍력、위장도반응방면다우량약화료조，차이유통계학의의（P＜0.05）。여Charlson≤3환자상비，유경고비례적Charlson＞3자발생Ⅲ혹Ⅳ급불량반응。결론대우만기불가수술절제적저분화노년위암환자응급여적겁적화료，연장생존시간，량약연합방안치료료효병불차우삼약방안，병차불량반응가내수，경괄합노년환자，치득진일보연구。
Objective In this study, safety and efficacy of docetaxel-containing doublet regimen or triplet regimen will be investigated. Methods A total of 54 elderly patients with local advanced gastric cancer who were given combined chemotherapy were analyzed retrospectively. There were 36 male and 18 female in this study.The median age was 70.9 years old (range:65 to 80 years old). 13 patients (54.3%) had Charlson score>3.29 patients received docetaxel plus oxaliplatin chemotherapy and 25 patients received docetaxel plus oxaliplatin and S-1 until disease progression or intolerance. Efficacy and safety were evaluated every two cycles. Results 54 patients completed an average of 4.8 cycles of chemotherapy.The ORR of doublet regimen group and triplet regimen group was 37.9%and 36.0%, the CBR of two group was 65.5% and 72.0%, the TTP was 8.4 m and 8.6 m, OS was 12.9 m and 15.3 m. The data had no significant differences. The OS of Charlson≤3 group and Charlson>3 group was 15.6 m and 12.9 m. Compared to Charlson≤3 patients, Charlson>3 patients have shorter OS. The adverse reactions could be tolerated in 54 patients. The mainly adverse reactions were myelosuppression, alopecia, gastrointestinal reaction and the weak, mostly Ⅰ-Ⅱ, Ⅲ-Ⅳ degree. Triplet regimen group had more adverse reactions of bone marrow suppression, gastrointestinal reactions and weak than doublet regimen group. The difference was statistically significant (P<0.05). Compared to Charlson≤3 patients, Charlson>3 patients had a higher proportion of adverse reactions. Conclusion For the elderly poorly differentiated gastric cancer patients with advanced unresectable should be given aggressive chemotherapy to prolong survival time. Doublet regimen group and Triplet regimen group have no difference. Adverse reactions can be tolerated .This regime is worth further study.