奥沙利铂联合卡培他滨新辅助化疗方案对进展期胃癌手术切除率及预后的影响  

Effects of XELOX regimen as neoadjuvant chemotherapy on radical resection rate and prognosis in patients with advanced gastric cancer

作　　者：赵群[1] 李勇[1] 檀碧波[1] 田园[1] 焦志凯[1] 赵雪峰[1] 张志栋[1] 王冬[1] 杨沛刚[1] 

机构地区：[1]河北医科大学第四医院外三科,石家庄050011

出　　处：《中华肿瘤杂志》2013年第10期773-777,共5页Chinese Journal of Oncology

基　　金：国家自然科学基金（81072033）;河北省自然科学基金（C2010000619）;河北省普通高校强势特色学科项目（冀教高2005-52）;河北省卫生厅科研基金（20110460）

摘　　要：目的 探讨奥沙利铂联合卡培他滨新辅助化疗对进展期胃癌的治疗效果及其作用机制.方法 采用随机数字表法将85例ⅡB～ⅢC期胃癌患者随机分为新辅助化疗组（40例）和单纯手术组（45例）.新辅助化疗组化疗后均接受开放手术治疗,单纯手术组则直接行手术治疗.比较两组患者的R0切除率、总生存时间和无病生存时间.流式细胞术检测肿瘤细胞的细胞周期和凋亡率.Western blot法检测肿瘤细胞中增殖细胞核抗原（PCNA）、p21、p53、survivin蛋白的表达.结果 新辅助化疗的总有效率为32.5％,肿瘤控制率为90％,不良反应发生率低.新辅助化疗组患者的R0切除率为87.5％,高于单纯手术组（73.3％,P＜0.05）.新辅助化疗组患者的平均总生存时间为25.4个月,单纯手术组为22.8个月（P =0.376）.新辅助化疗组患者的平均无病生存时间为24.4个月,单纯手术组为19.9个月（P =0.155）.流式细胞术检测结果显示,新辅助化疗组和单纯手术组肿瘤细胞处于G0/G1期的比例分别为（77.59±4.36）％和（72.04±4.02）％,差异有统计学意义（P＜0.05）.新辅助化疗组和单纯手术组S期细胞的比例分别为（12.54±2.93）％和（17.80±2.96）％,差异有统计学意义（P＜0.05）.新辅助化疗组和单纯手术组肿瘤细胞的凋亡率分别为（15.67 ±2.84）％和（7.89±1.03）％,差异有统计学意义（P＜0.05）.Western blot检测结果显示,新辅助化疗组肿瘤细胞中PCNA、survivin蛋白的表达明显低于单纯手术组,而p21、p53蛋白的表达高于单纯手术组（均P＜0.05）.结论 奥沙利铂联合卡培他滨新辅助化疗可以明显提高进展期胃癌R0切除率,延长患者的生存时间,其作用机制可能与药物抑制肿瘤细胞增殖、促进凋亡有关.Objective The purpose of this study was to investigate the efficacy and mechanism of oxaliplatin in combination with capecitabine （XELOX） regimen as neoadjuvant chemotherapy in the treatment of patients with advanced gastric cancer. Methods Eighty-five patients with advanced gastric cancer （stage Ⅱ B and Ⅲ c） were randomly divided into two groups： neoadjuvant chemotherapy group （40 cases） and surgery alone group （45 cases）. In the neoadjuvant chemotherapy group, patients received oral administration of Xeloda 1000 mg/m2 twice a day on days 1-14 and intravenous infusion of oxaliplatin 130 mg/m2 on day 1 （XELOX regimen）. The regimen was repeated every 21 days. In the surgery alone group, patients directly received radical resection of gastric cancer. The R0 resection rate, overall survival and disease free survival （DFS） were observed in all cases. The cycles and apoptosis rate of the gastric cancer cells were detected by flow cytometry. The expression of proliferating cell nuclear antigen （PCNA）, p21, p53 and survivin was detected by Western blot. Results In the neoadjuvant chemotherapy group, the total effective rate was 32.5% （13/40）, and the tumor control rate was 90% （36/40）, with few side effects. Compared with the surgery alone group, R0 resection rate was significantly higher in the neoadjuvant chemotherapy group （P 〈 0.05 ）. The survival analysis indicated that both the overall survival and DFS werelonger in the neoadjuvant chemotherapy group in comparison with those in the surgery alone group, but no significant differences were found （ P 〉 0.05 ）. In the neoadjuvant chemotherapy group, both the apoptosis rate and the ratio of cells in stage Go and G were significantly higher than those in the surgery alone group （ P 〈 0.05 ）. The expression of PCNA and survivin was lower in the neoadjuvant chemotherapy group, while the expression of p21 and p53 was higher. Conclusions XELOX regimen as neoadjuvant chemotherapy in the treatment of patients with ad

关 键 词：胃肿瘤 新辅助化疗 预后 分子作用机制 

分 类 号：R735.2[医药卫生—肿瘤]