紫杉醇联合顺铂新辅助化疗对Ⅲ期食管癌手术风险及预后的影响  

Influence of neoadjuvant chemotherapy of paclitaxel and cisplatin on surgical risk and prognosis in patients with stage Ⅲ esophageal cancer

作　　者：强勇[1] 杨楠[1] 董国华[1] 申翼[1] 姚圣[1] 钱建军[1] 罗立国[1] 吴海卫[1] 李德闽[1] 李忠东[1] 

机构地区：[1]南京军区南京总医院心胸外科,南京210002

出　　处：《临床肿瘤学杂志》2016年第2期166-169,共4页Chinese Clinical Oncology

摘　　要：目的探讨紫杉醇联合顺铂新辅助化疗对Ⅲ期食管癌患者实施手术的风险及对预后的影响。方法回顾分析2009年1月至2012年6月收治的140例Ⅲ期食管癌患者,根据治疗情况分为单纯手术组(n=78)和新辅助化疗组(n=62)。单纯手术组仅接受手术治疗。新辅助化疗组于术前给予紫杉醇联合顺铂化疗,具体方案为:紫杉醇135 mg/m^2静滴,d1;顺铂30 mg/m^2静滴,d1~d3,21天为1周期,化疗2个周期。化疗结束后4周行手术治疗。比较两组的手术切除根治率、术后并发症和总生存期(OS)。结果 62例接受新辅助化疗患者中,获CR 4例、PR 34例、SD 21例、PD 3例,有效率为61.3%。化疗的主要不良反应为白细胞减少、肝肾功能损伤、消化道反应和脱发,均为1~2级。新辅助化疗组的根治性切除率为91.9%(57/62),高于单纯手术组的69.2%(54/78),差异有统计学意义(P=0.001);两组围手术期均无1例死亡,新辅助化疗组的术后并发症发生率为30.6%,单纯手术组为25.6%,两组差异无统计学意义(P=0.512)。新辅助化疗组的中位OS为17.8个月(95%CI:14.5~21.1个月),单纯手术组为14.2个月(95%CI:11.6~16.8个月),两组差异有统计学意义(P=0.016)。结论针对Ⅲ期食管癌患者,术前采用新辅助化疗有助于提高肿瘤切除率,且不增加并发症发生率,有效提高患者的OS,值得临床推广应用。Objective To investigate the effect of neoadjuvant chemotherapy of paelitaxel and eisplafin on the surgical risk and prognosis of patients with stage Ⅲ esophageal cancer. Methods From January 2009 to June 2012, 140 esophageal cancer patients with stage Ⅲ were divided into simple operation group（ n = 78） and neoadjuvant chemotherapy group（ n = 62） , respectively. The neoad- juvant chemotherapy group received paclitaxel plus cisplatin chemotherapy regimen before operation（ paclitaxel 135 mg/m2, dI ; eispla- tin 30 mg/m2, dt -d3, 21 days a cycle for two consecutive cycles）. The operation was performed 4 weeks after chemotherapy. The surgi- cal resection rate, postoperative complications and overall survival（OS） were compared between both groups. Results Among 62 pa- tients receiving neoadjuvant chemotherapy, 4 cases got CR, 34 cases got PR, 21 cases were in SD, 3 cases were in PD and the effec- tive rate of 61.3%. The main side effects were leukopenia, digestive reaction, hepatic and renal dysfunction and hair loss in grade 1-2. The radical resection rate of neoadjuvant chemotherapy group was 91.9% （57/62） , higher than 69.2% （54/78） in the simple operation group（ P= 0. 001 ）. There was no perioperative death in both groups. The incidence of postoperative complications of neoadju- vant chemotherapy group and simple operation group were 30. 6% and 25.6% without statistical significance（ P= 0. 512）. The new ad- juvant chemotherapy group showed significantly better median OS compared to the simple operation group（ 17.8 months vs. 14. 2 months P = 0. 016）. Conclusion In the treatment of stage Ⅲ esophageal cancer, neoadjuvant chemotherapy is helpful to improve tumor resec- tion rate, without increasing the incidence of complications, and can effectively improve the clinical efficacy and OS, which is worthy of clinical application.

关 键 词：食管癌 新辅助化疗 紫杉醇 顺铂 

分 类 号：R735.1[医药卫生—肿瘤]