不同氟尿嘧啶制剂联合奥沙利铂治疗进展期胃癌的临床观察  

Retrospective study on three different fuoropyrimidines regimens in combination with oxaliplatin for patients with advanced gastric carcinoma

作　　者：樊翠珍[1] 戴红[1] 黄冬方[1] 于丹[1] 葛洋[1] 周围围[1] 范姗姗[1] 严冬[1] 刘月明[1] 初玉平[1] 

机构地区：[1]首都医科大学附属北京朝阳医院肿瘤科,北京100020

出　　处：《中华肿瘤防治杂志》2013年第7期539-543,共5页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的:评价3种不同氟尿嘧啶类药物联合奥沙利铂(L-OHP)的化疗方案治疗进展期胃癌的有效性和安全性。方法:回顾性分析2005-01-2010-12我院治疗进展期胃癌179例,分3组。A组(FOLFOX4)78例:L-OHP 85mg/m2,持续静脉滴入2h,d1;CF 200mg/m2,静脉滴入2h;5-FU 400mg/m2,静脉推注;5-FU 600mg/m2持续静脉滴入22h,d1～d2,14d为1个周期,4周期评价疗效。B组(XELOX)57例:L-OHP 130mg/m2,持续静脉滴入2h,d1,卡培他滨1 000mg/m2,口服,2次/d,d1～d14,21d为1个周期。C组(L-OHP+S-1)44例:L-OHP同方案B组,S-1 40mg/(m2.d),2次/d,口服,d1～d14,餐后服用;21d为1个周期,2个周期评价疗效及毒性。比较治疗前后血常规、肝肾功能、胸腹部CT扫描及胃镜等检查的变化,分析近期疗效及化疗不良反应;采用Kaplan-Meier法,Log-Rank检验比较两组患者的生存期及疾病进展时间。结果:179例均可评价疗效,A、B和C组的有效率(RR)分别为38.5%(30/78)、43.8%(25/54)和45.5%(20/44),差异无统计学意义,χ2=0.679,P=0.738;疾病控制率(DCR)分别为52.8%(44/78)、70.2%(40/54)和68.2%(30/44),差异有统计学意义,χ2=9.856,P=0.007;B和C组比较差异无统计学意义,χ2=0.231,P=0.976;中位疾病进展时间(mTTP)为5.4、6.3和6.5个月,差异有统计学意义(χ2=7.935,P=0.019),B和C组差异无统计学意义,χ2=0.001,P=0.971;中位生存时间(mOS)分别10.0、13.5和14.0个月,差异无统计学意义,χ2=5.895,P=0.052。三组患者的不良反应中,恶心、呕吐及骨髓抑制发生率差异无统计学意义(P>0.05),C组的口腔黏膜炎高于A和B组,P<0.05。结论:3种不同氟尿嘧啶制剂联合L-OHP治疗进展期胃癌有效,且不良反应可耐受,其中口服制剂效果较好。OBJECTIVE：To evaluate the efficacy and toxicities of three different fuoropyrimidines regimens in combi nation with oxaliplatin for patients with previously untreated advanced gastric carcinoma （AGC）. METHODS： One hun dred and seventy-nine patients with AGC were included in the study according to the inclusion criteria from January 2005 to December 2010. Among of these patient： Group A （FOLFOX4） ：78 patients were treated with oxaliplatin 85 mg/m2 on day 1, FA 200 mg/m2 as a 2 h infusion followed by bolus 5-FU 400 mg/m2 and a 22 h infusion of 5-FU 600 mg/m2 , re peated for consecutive clays every 2 weeks. Four weeks was a cycle. Group B （XELOX） ..57 patients were treated with ox aliplatin 130 mg/m2 ,on day 1 ,capecitabine 1 000 mg/m2 orally twice daily for 14 day every 3 weeks. The median cycles of treatment were 4 cycles. Group C（L-OHP S-1）： 44 patients were treated with oxaliplatin as that of group B, S-1 40 mg/m2 orally twice daily for 14 day every 3 weeks. The median cycles of treatment were 4 cycles. Blood routine function of liver and kidney,chest and abdomen- CT or MRI were examined before and after treatment. The changes of cancer focus size,clinical symptoms,toxic and side effects were recorded and compared. The survival data in three groups were compared using the log rank test based on Kaplan-Meier survival curves. RESULTS： All patients were assessable for toxicity and response to treatment. In A, B, C group, the remission rate were 38. 5% （30/78）, 43. 8% （25/54） and 45. 5%（20/44） ,respectively. There was no significance among three groups （X2 = 0. 679, P= 0. 738）, while the disease control rate were 52.8 % （44/78）, 70.2 40/54） and 68.2 % （30/44）, respectively. Three groups showed statistically meaningful improvement （X2 9. 856,P=0. 007）. The median time to progress were 5.4,6.3 and 6.5 months （X2= 7. 935, P = 0. 019） while the median overall survival were 10.0,13.5 and 14.0 months （X2 =5. 895,P =0. 052） ,respectively. There was no signi

关 键 词：胃肿瘤 药物疗法 氟尿嘧啶 有机铂化合物 抗肿瘤联合化疗方案 治疗应用 

分 类 号：R735.2[医药卫生—肿瘤]