新辅助化疗对局部进展期胃癌营养状况影响的临床研究  

Effect of neoadjuvant chemotherapy on nutritional status of locally advanced gastric cancer

作　　者：邓国鹏 曲建军[1] 翟升永[1] 石毅然[1] 王新波[1] Deng Guopeng;Qu Jianjun;Zhai Shengyong;Shi Yiran;Wang Xinbo

机构地区：[1]山东省潍坊市人民医院肿瘤外科 潍坊医学院外科学教研室,261041

出　　处：《中华胃肠外科杂志》2018年第3期331-335,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：山东省潍坊市科学技术发展计划（20122048）

摘　　要：目的研究新辅助化疗对局部进展期胃癌营养状况的影响。方法病例纳入标准：（1）18～65岁；（2）经胃镜下活检确诊为胃癌；（3）根据2000年AJCC分期标准，术前分期为TNM Ⅲ期；（4）Kamosfsky功能状态评分〉 60分；（5）自愿选择新辅助化疗并签署知情同意书。病例排除标准：（1）有化疗及手术禁忌证；（2）患有心、肝、肾等基础疾病；（3）并发其他恶性疾病、消耗性疾病或其他消化系统疾病。按照上述标准，前瞻性收集山东省潍坊市人民医院2015年5月至2017年3月期间，行新辅助化疗的73例Ⅲ期胃癌患者的病历资料，采用队列研究方法。剔除3例未完成化疗的患者后，最终共有70例完成化疗的患者被纳入本研究。全组患者均采用SOX方案（奥沙利铂加替吉奥）进行化疗，化疗期间未进行营养支持治疗。分析患者化疗前后体成分和营养学指标变化，并根据化疗后肿瘤消退情况，分为有反应组（肿瘤完全或次全退缩）和无反应组（肿瘤部分、少量或无退缩）进行分层分析。结果70例胃癌患者中，男性40例，女性30例，年龄28～64（53.8 ± 6.4）岁。Ⅲa期26例（37.1%），Ⅲb期35例（50.0%），Ⅲc期9例（12.9%）。新辅助化疗有反应组41例，新辅助化疗无反应组29例。新辅助化疗有反应组完全缓解（CR）3例（4.3%），部分缓解（PR）38例（54.3%）；新辅助化疗无反应组疾病稳定（SD）23例（32.9%），疾病进展（PD）6例（8.6%）。新辅助化疗后，全组患者细胞外液从（13.3 ± 1.7）L升高至（13.5 ± 1.6）L（t = -2.044，P = 0.045），细胞内液从（21.4 ± 2.5）L下降至（21.1 ± 2.4）L（t = 2.369，P = 0.021），淋巴细胞计数从（0.31 ± 0.10）×10^9/L下降至（0.29 ± 0.10）×10^9/L（t = 1.706，P = 0.009），其余指标差异无统计学意义（均P 〉 0.05）。分层分析显示，化疗后，新辅助化疗有反应组体质ObjectiveTo study the effect of neoadjuvant chemotherapy on nutritional status in patients with locally advanced gastric cancer.MethodsCases inclusion criteria： （1） 18-65 years old; （2） Gastric cancer confirmed by gastroscopic biopsy; （3） Preoperative TNM stage Ⅲ according to the AJCC stage 2000 standard; （4） Kamosfsky functional status score〉 60 points; （5） Receiving neoadjuvant chemotherapy voluntarily and signing the informed consent form. Case exclusion criteria： （1） Having contraindications of chemotherapy and surgery; （2） Suffering from heart, liver and kidney and other underlying diseases; （3） Concurrent with malignant diseases, wasting disease or other digestive diseases. According to the above criteria, clinical data of 73 patients of stage Ⅲ gastric cancer receiving neoadjuvant chemotherapy at Weifang People′s Hospital from May 2015 to March 2017 were prospectively collected. The cohort study was adopted. After removing 3 patients who did not complete the chemotherapy, a total of 70 patients who completed the chemotherapy were included in the study. All the patients received SOX chemotherapy without nutritional support during chemotherapy. Changes of body composition and nutritional indicators were analyzed before and after chemotherapy, and according to the tumor regression after chemotherapy, patients were divided into response group （complete or sub-total tumor regression） and non-response group （tumor part, with or without a small amount of retreat） for stratified analysis.ResultsOf 70 gastric cancer patients, 40 were male and 30 were female with a age of （53.8 ± 6.4） （28 to 64） years. There were 26 cases （37.1%） of stage Ⅲ a, 35 cases （50.0%） of stage Ⅲ b and 9 cases （12.9%） of stage Ⅲ c. There were 41 cases in response group and 29 cases in non-response group. Three patients （4.3%） were complete remission （CR） and 38 patients （54.3%） were partial remission （PR） in response group, while 23 cases （32.9%�

关 键 词：胃肿瘤 新辅助化疗 围手术期 营养状况 

分 类 号：R735.2[医药卫生—肿瘤]