胃及胃食管连接部腺癌单纯手术治疗与术后联合放化疗的疗效比较  

Chemoradio therapy after surgery compared with surgery alone on adenocarcinoma of the stomach or gastroesophageal junction

作　　者：周广信[1] 蒋雪超[1] 刘永利[1] 王国栋[2] 

机构地区：[1]山东省滨州市中心医院结防院肿瘤科,251700 [2]山东省潍坊市人民医院

出　　处：《临床内科杂志》2010年第4期246-248,共3页Journal of Clinical Internal Medicine

摘　　要：目的比较胃及胃食管连接部腺癌患者单纯手术治疗与术后联合放化疗的疗效。方法将156例胃及胃食管连接部腺癌患者随机分成单纯手术组和手术后联合放化疗组。所有患者均行胃及扩大的淋巴结切除（D2）。其中联合放化疗组患者联合氟尿嘧啶加亚叶酸的化疗及放疗。结果单纯手术组患者平均生存时间为27个月，联合放化疗组患者平均生存时间为36个月。单纯手术组死亡的危险度（HR）与联合放化疗组之比为1．35（22．3：16．5）（95％的可信区间：1．09—1．66，P=0．05）；单纯手术组癌症复发的危险度（rm）与联合放化疗组之比为1．52（37．2：24．5）（95％的可信区间：1．23～1．86，P〈0．01）。联合放化疗组患者无复发平均生存30个月，单纯手术组平均为19个月（P〈0．05）；联合放化疗组3年无复发生存率为48％，单纯手术组为31％（P〈0．05）。结论胃及胃食管连接部腺癌有复发的可能，高危患者均应在术后进行放化疗。Objective To compare the clinical effect of Chemoradio therapy after surgery versus surgery alone on adenocarcinoma of the stomach or gastmesophageal junction. Methods A total of 156 patients with adenocarcinoma of the stomach or gastroesophageal junction were randomly divided into surgery plus postoperative chemoradiotherapy group or surgery alone group. Gastric resection with an extensive lymphnode dissection（D2） was recommended. The combination group received fluorouracil plus leucovorin and radio theraphy. Results The median survival in the surgery alone group was 27 mouths, while it was 36 months in the chemoradiotherapy group. The hazard ratio for death was 1.35 （22.3：16.5 ） （95 percent confidence interval, 1.09 to 1.66 ; P = 0. 05 ）. The hazard ratio for relapse was 1.52 （ 37.2 ： 24.5 ） （ 95 percent confidence interval, 1.23 to 1.86;P 〈 0.01 ）. The median duration of relapsefree survival was 30 months in the chemoradiotherapy group and 19 months in the surgery-only group. The rates of relapse-free survival for three-years were 48 percent in the chemoradiotherapy group and 31 percent in the surgery alone group. Conclusions Postoperative chemoradiotherapy should be taken for all patients with high risk for recurrence of adenocarcinoma of the stomach or gastroesophageal junction who have undergone curative resection.

关 键 词：胃腺癌 氟尿嘧啶 亚叶酸 

分 类 号：R735.2[医药卫生—肿瘤]