改良XELOX方案治疗胃癌伴肝转移  

Study on modified XELOX regimen for treatment of gastric cancer with liver metastasis

作　　者：李慧[1] 江旭[1] 杨继金[1] 杨朝爱[1] 王卫星[1] 陈文会[1] 刘敬禹[1] 马青[1] 

机构地区：[1]第二军医大学附属长海医院介入科,上海200433

出　　处：《西部医学》2016年第4期520-523,共4页Medical Journal of West China

基　　金：上海市科委科研项目(14411960300)

摘　　要：目的探讨改良XELOX方案治疗胃癌伴肝转移的有效性和安全性。方法分析收治的22例胃癌伴肝转移患者的临床资料,均经胃镜、病理活检证实,未行原发灶切除术,且接受至少2个疗程的改良XELOX方案的治疗。改良XELOX方案即是指将传统XELOX（卡培他滨＋奥沙利铂）方案中的静脉滴注奥沙利铂更改为动脉灌注且留置导管缓慢泵注1个小时。每2个月通过CT和/或MRI检查肝内转移灶,胃镜检查原发灶。随访其生存时间,按RECIST标准评价客观疗效。采用SPSS 19.0软件运用Kaplan-Meier法进行分析。结果 22例病人均可评价疗效,共行145次肝动脉化疗栓塞（TACE）术。中位总生存期（OS）为18.0个月,95%CI（14.2,21.8）获CR 1例,PR 9例,SD 7例,PD 5例,有效率（RR）为45.5%,临床受益率（CBR）为77.3%,中位无进展生存期（PFS）为5.0个月,95%CI（0.0,13.4）。治疗后不良反应主要为恶心、呕吐、疼痛、肝功能受损、骨髓抑制、外周感觉神经毒性等,多为Ⅰ~Ⅱ度,无治疗相关性死亡。其中恶心、呕吐均有不同程度发生,其次主要为疼痛、肝功能受损,但仅局限于TACE治疗后3~5天;骨髓抑制主要为白细胞、血小板减少。结论改良XELOX方案治疗胃癌伴肝转移患者疗效确切,具有较高的临床受益率,能改善患者的生活质量,增加手术切除机会,不良反应可耐受。Objective To explore the effectiveness and safety of modified XELOX for the treatment of gastric cancer with liver metastasis.Methods The clinical data of 22 patients with gastric cancer accompanied by liver metastasis admitted to our hospital from August 2006 to December 2014 were retrospectively analyzed.All the patients were confirmed by pathological biopsy or gastroscopic examination and received at least two courses of modified XELOX regimen.Liver metastases were examined by CT and/or MRI and primary tumor by gastroscopy every 2months.RECIST was used to evaluate the objective response.SPSS 19.0and Kaplan-Meier methods were applied.Results All the 22 patients received a total of 145 times of TACE treatment and can be evaluated.Median overall survival（OS）was 18.0months,95% CI（14.2,21.8）,CR 1cases,PR 9cases,SD 7cases,PD 5cases,the efficiency（RR）was 45.5%,clinical benefit rate was77.3%.Median progression-free survival（PFS）was 5.0months,95% CI（0.0,13.4）;The adverse reactions after the treatment included nausea,vomiting,pain,impaired liver function,myelo-suppression,peripheral sensory neuropathy and so on,most of which presented as gradeⅠ-Ⅱ.There was no treatment-related death.All patients had nausea and vomiting of different degree.The second was pain and liver function abnormalities,which only lasted 3-5days after TACE;bone marrow suppression mainly presented as white blood cells and platelets decrease.Conclusion Modified XELOX regimen is effective in treating gastric cancer with hepatic metastases.It can commendably improve the quality of life of patients and increase opportunities for surgical resection and the adverse reactions can be tolerated.

关 键 词：胃 肝脏 肿瘤 转移 介入 

分 类 号：R735.2[医药卫生—肿瘤]