奥沙利铂联合5-FU术前动脉化疗对进展期胃癌的临床疗效  

Effects of preoperative arterial infusion chemotherapy with oxaliplatin and 5-FU for patients with advanced gastric cancer

作　　者：卞育海[1] 曹晖[1] 郁丰荣[1] 陈治平[1] 吴志勇[1] 

机构地区：[1]上海交通大学医学院附属仁济医院普通外科,上海200127

出　　处：《中国普通外科杂志》2009年第9期955-959,共5页China Journal of General Surgery

摘　　要：目的探讨进展期胃癌患者术前用奥沙利铂（OXA）联合5-氟尿嘧啶（5-FU）行区域性动脉灌注化疗的临床效果。方法48例Ⅱ期以上胃癌患者，术前行区域性动脉灌注化疗（A组），方案为OXA 130mg／m^2 ＋5-Fu750mg／m^2，经股动脉插管行区域冲击化疗1次，8～12d后接受手术。同期另48例相同临床分期的胃癌患者直接行手术治疗（B组）。两组术后均接受OXA／甲酰四氢叶酸钙／5-FU方案化疗6个周期，观察两组的毒副反应、手术并发症和临床疗效。结果A组有38例（79．2％）获得根治性切除；镜检32例（66．7％）出现组织病理学改变，如肿瘤组织坏死、淋巴细胞炎性浸润、癌细胞凋亡、以及间质水肿纤维组织增生等。B组有30例（62．5％）行根治性切除，根治切除率显著低于A组，两组间差异有统计学意义（P〈0．05），且B组病理检查未出现上述变化。A组术前化疗的毒性反应均限于Ⅰ～Ⅱ级；两组的术后并发症无统计学差异。A组患者的中位生存期为36．0个月；1，2，3年总生存率分别为79．2％，62．5％和52．1％。B组中位生存期为21．5个月；1，2，3年总生存率分别为66．7％，45．8％和35．4％。A，B组比较，2年和3年总生存率差异有统计学意义（P〈0．05）。结论术前应用OXA／5-FU方案行区域性动脉灌注化疗可使肿瘤组织产生显著的组织病理学改变，有利于提高进展期胃癌根治性手术切除率及2，3年生存率。Objective To discuss the clinical effects of preoperative arterial infusion chemotherapy with oxaliplatin （OXA） and 5-fluorouracil （5-FU） in patients with advanced gastric cancer. Methods Forty-eight patients of advanced gastric cancer （Phase II plus ） received regional intra-arterial infusion chemotherapy before operation （ Group A ） . The regimen consisted of one dose of OXA 130 mg/m^2 and 5-FU750mg/m^2 , administrated through the femoral artery catheterization, and operation 8 to 12 days later. During the same period, other 48 cases of gastric cancer in the same clinical stage （ Group B ） were given surgery directly. All 96 patients were treated with postoperative chemotherapy intravenously by use of OXA/leucovorin/5-FU for six cycles. Results In group A, 38 patients （79. 2% ） received radical resection （R0 resection）. Microscopically, 32 cases （66. 7% ） showed varied histopathological changes, which included tumor necrosis, lymphocyte infiltration, residual cancer ceils apoptosis, interstitial edema, and fibrosis. In group B, 30 patients （ 62. 5 % ） unclerwent R0 resection, which was lower than that of group A （ P 〈 0. 05 ） , but no similar pathological changes of group A were observed. The toxicities of preoperative arterial infusion chemotherapy were well tolerated and restricted to Grade Ⅰ-Ⅱ. There was no difference in postoperative complications between the two groups. The median survival period of group A was 36.0 months, and the l, 2 and 3-year overall survival rate was 79. 2%, 62. 5% and 52. 1%, respectively. In group B, the median survival time was 21.5 months, and the 1 , 2, 3-year overall survival rate was 66. 7%, 45. 8% （P 〈 0. 05） and 35. 4% （P 〈 0. 05）, respectively. Conclusions Preoperative arterial infusion chemotherapy with OXA and 5-FU can cause significant histopathological changes that can improve the R0 resection rate and improve the 2-3 year overall survival of advanced gastric cancer.

关 键 词：胃肿瘤 新辅助化疗 动脉灌注 奥沙利铂 5-氟尿嘧啶 

分 类 号：R735.2[医药卫生—肿瘤]