卡培他滨或替吉奥联合奥沙利铂方案治疗进展期胃癌的疗效及安全性  

Comparison of the efficacy and safety of capecitabine or tegafur, gimeracil and oteracil potassium capsules combined with oxaliplatin chemotherapy regimens in the treatment of advanced gastric cancer

作　　者：万一元[1] 惠红霞[1] 王晓炜[1] 吴健[2] 孙苏安[2] 

机构地区：[1]南京医科大学附属淮安第一医院肿瘤内科,223300 [2]南京医科大学附属淮安第一医院病理科,223300

出　　处：《中华肿瘤杂志》2016年第1期28-34,共7页Chinese Journal of Oncology

摘　　要：目的观察卡培他滨或替吉奥联合奥沙利铂方案治疗进展期胃癌的疗效及安全性，探讨肿瘤组织中胸腺嘧啶磷酸化酶（TP）、二氢嘧啶脱氢酶（DPD）蛋白的表达与化疗疗效的关系。方法选取初治、111C～Ⅳ期胃癌、无手术指征、体能状态评分为0～2分、预计生存期≥3个月的患者，采用抽签法将患者随机分为病例组和对照组，分别接受CAPOX方案（奥沙利铂＋卡培他滨）和SOX方案（奥沙利铂＋替吉奥），无效者更换二线化疗方案。采用免疫组化检测肿瘤组织中TP、DPD蛋白的表达。结果病例组和对照组患者的客观缓解率（ORR）分别为49．0％（25／51）和46．0％（23／50），差异无统计学意义（P〉0．05）。病例组患者总生存时间（Os）和疾病进展时间（1T11P）分别为（357．36±24．69）d和（216．75±19．32）d，对照组分别为（349．87±22．63）d和（220．54±18．47）d，差异无统计学意义（P〉0．05）。TP表达阳性的患者中，病例组患者的ORR（72．O％）高于对照组（41．7％，P=0．032）；TP表达阴性的患者中，病例组和照组患者的ORR分别为26．9％和50．0％，差异无统计学意义（P=0．087）。而DPD表达阳性的患者中，病例组患者的ORR（34．6％）低于对照组（51．9％，P=0．046）；DPD表达阴性的患者中，病例组和对照组患者的ORR分别为39．1％和64．0％，差异无统计学意义（P=0．084）。TP表达阳性的患者中，病例组患者的OS和TTP为（378．42±22．56）d和（271．77±24．92）d，对照组分别为（326．57±19．84）d和（229．13±22．68）d，差异均有统计学意义（均P〈0．05）；DPD表达阳性的患者中，对照组患者的OS和TTP分别为（371．25±23．97）d和（264．66±21．36）d，病例组患者分别为（334．73±21．47）d和（208．58±20．70）d，差异均有统计学意义（均P〈0．05）；而TP或DPD表达阴性的患者中，Objective To observe the efficacy and safety of chemotherapy regimens oxaliplatin combined with capecitabine （CAPOX） or oxaliplatin combined with tegafur, gimeracil and oteraeil potassium eapsules （S-I）（SOX）, and to investigate the value of expression of thymidine phosphorylase （TP） and dihydropyrimidine dehydrogenase （DPD） proteins in tumor tissue for predicting the efficacy of CAPOX and SOX regimens in advanced gastric cancer patients. Methods A total of 107 newly-diagnosed, stage m c/IV gastric cancer patients （ no surgical indication, ECOG performance scores 0-2 and expected survival time ≥3 months） were recruited with 101 patients evaluated. The patients were randomly divided into two groups. One was study group in which the patients received CAPOX regimen. The other was control group received SOX regimen. Each patient received four cycles, at least two cycles chemotherapy every three weeks and followed up until death or lost. Tumor biopsies were obtained by gastroscopy for immunobistochemical examination of the expression of TP and DPD proteins before chemotherapy. Response rate （ORR）, overall survival （OS） and time to tumor progression （TTP） of the patients were assessed. Results The objective response rate （ORR） of the study and control groups was 49.0% （5/51） vs. 46.0% （23/50）, respectively （P〉0.05）. The overall survival （OS） was 357.36±24.69 days in the study group and 349.87±22.63 days in the control group, and the time-to-progression （TIP） was 216.75±19.32 days in the study group and 220.54± 18.47 days in the control group （P〉0.05 for both）. Stratified analysis showed that the ORR of TP-positive patients in the study group was significantly higher than that in the control group （72.0 % vs. 41.7 %, P= 0.032）. There was no significant difference in ORR between the TP-negative patients in the study and control groups （26.9% vs. 50.0%, P=0.087）, while the ORR of DPD-positive patients in the control group was significantly hi

关 键 词：胃肿瘤 抗肿瘤联合化疗方案 胸腺嘧啶磷酸化酶 二氢嘧啶脱氢酶 卡培他滨 替吉奥 奥沙利铂 治疗结果 

分 类 号：R735.2[医药卫生—肿瘤]