洛铂联合替吉奥治疗进展期胃癌的疗效及循环肿瘤细胞在预测化疗疗效中的作用  

Efficacy of lobaplatin plus S-1 and the predictive value of circulating tumor cell in patients with advanced gastric cancer

作　　者：冯倩[1] 赵景润[1] 张爱霞[1] 李森林[1] Feng Qian;Zhao Jingrun;Zhang Aixia;Li Senlin(Department of Gastroenterology,Liaocheng People＇s Hospital,Liaocheng 252000,China（Feng Q,Zhao JR,Zhang AX,Li SL)

机构地区：[1]聊城市人民医院消化内科,252000

出　　处：《中华肿瘤杂志》2018年第9期696-702,共7页Chinese Journal of Oncology

摘　　要：目的研究洛铂（LBP）联合替吉奥（S－1）治疗进展期胃癌（AGC）的疗效及血清循环肿瘤细胞（CTC）在评估化疗疗效和预测预后方面的作用。方法收集2014年1月至2015年2月聊城市人民医院收治的64例行LBP联合S－1化疗AGC患者的资料，记录其临床特点、化疗疗效、不良反应、生存时间、化疗前后CTC水平等，并分析化疗前后CTC水平与疾病控制率（DCR）、客观缓解率（ORR）、无进展生存时间（PFS）和总生存时间（OS）的关系。结果64例患者均完成2个周期化疗。部分缓解24例（37.5%），疾病稳定18例（28.1%），疾病进展22例（34.4%），客观缓解率（ORR）为37.5%，疾病控制率（DCR）为65.6%。全组患者的中位PFS为10.8个月（95%CI为7.1～12.0个月），中位OS为16.1个月（95%CI为12.4～18.8个月）。化疗前，CTC≥2个和CTC〈2个患者的ORR分别为25.0%和53.6%，差异无统计学意义（P＝0.150）；DCR分别为47.2%和89.3%，差异有统计学意义（P＝0.008）。化疗2个周期后，CTC≥2个和CTC〈2个患者的ORR分别为16.7%和50.0%，差异有统计学意义（P＝0.007）；DCR分别为45.9%和90.0%，差异有统计学意义（P＝0.015）。化疗前，CTC≥2个患者的中位PFS为6.2个月，CTC〈2个患者的中位PFS为7.5个月，差异无统计学意义（P＝0.780）；CTC≥2个患者的中位OS为10.5个月，CTC〈2个患者的中位OS为17.2个月，差异有统计学意义（P〈0.001）。化疗2个周期后，CTC≥2个患者的中位PFS为6.6个月，明显短于CTC〈2个患者的中位PFS（8.9个月，P〈0.001）；CTC≥2个患者的中位OS为8.4个月，明显短于CTC〈2个患者的中位OS（15.0个月，P＝0.002）。治疗前后CTC均较低或治疗后CTC降低者的中位PFS和中位OS较长，而治疗前后CTC均处于高水平或治疗后CTC上升者的中位PFS和中位OS则较短。化疗不良反应以胃肠道反应及骨髓抑制为主，绝大多数为Ⅰ、Ⅱ级反应，�Objective To investigate the efficacy and safety of lobaplatin （LBP） plus S-1 tot advanced gastric eancer （ AGC ） and determine the potential role of circulating tumor cells （ CTC ） for predicting the therapeutic response and prognosis. Methods From January 2014 to February 2015,64 consecutive patients with AGC received lobaplatin plus S-I chemotherapy in Liaocheng People＇s Hospital. The clinical features, clinical response, adverse effects, prognosis and CTC pre and post-treatment were retrospectively analyzed. The correlation between CTC and patients＇ disease control rate （DCR）, objective response rate （ORR）, progression free survival （PFS） as well as overall survival （OS） were investigated. Results All 64 patients completed 2 cycles of chemotherapy.The number of patients who achieved complete regression, partial regression, stable and progression were 0, 24 （37.5%） , 18 （28.1%） and 22 （34.4%） , respectively. ORR was 37.5% and DCR was 65.6%. The median PFS was 10.8 months （95% Cl 7.1-12.0） and the median OS was 16.1 months （95%CI 12.4-18.8）. The ORR and PFS were not significantly different between patients with baseline CTC≥2 and CTC〈2 （25.0% vs 53.6%, P=0.150; 6.2 months vs 7.5 months, P= 0.780） , while the DCR and OS were significantly different （45.9% vs 90.0%, P= 0.008; 10.5 months vs 17.2 months, P〈0.001 ）. After 2 cycles of chemotherapy, the ORR and DCR in patients with CTC ≥2 were 16.7% and 45.9%, respectively, which were significantly lower than those observed in patients with CTC〈 2 （50.0% and 90.0%, respectively）. The former also had shorter median PFS and OS （6.6 months vs 8.9 months, 8.4 months vs 15.0 months, respectively）. Patients with persistently CTC〈2 or those exhibiting an conversion to CTC〈2 following chemotherapy had an improved PFS and OS, while patients with persistently CTC≥ 2 or those exhibiting an conversion to CTC ~ 2 following therapy had shorter PFS and OS. The most frequent adverse effects were grad

关 键 词：胃肿瘤 洛铂 替吉奥 药物疗法 循环肿瘤细胞 

分 类 号：R735.2[医药卫生—肿瘤]