术前新辅助治疗Ⅲ期食管胃结合部腺癌近期疗效分析  

Analysis of the short-term efficacy of preoperative neoadjuvant therapy for stageⅢadenocarcinoma of the esophagogastric junction

作　　者：彭涛[1] 娄展 曹铭富 王晓元[3] 黄迪[3] 张桂云 高会斌[1] 李曙光[3] PENG Tao;LOU Zhan;CAO Mingfu;WANG Xiaoyuan;HUANG Di;ZHANG Guiyun;GAO Huibin;LI Shuguang(Endoscopic Room,the First Affiliated Hospital of Hebei North University,Hebei Zhangjiakou 075000,China;Department of Neurology,the First Affiliated Hospital of Hebei North University,Hebei Zhangjiakou 075000,China;Department of Gastrointestinal Cancer Surgery,the First Affiliated Hospital of Hebei North University,Hebei Zhangjiakou 075000,China)

机构地区：[1]河北北方学院附属第一医院内镜室,河北张家口075000 [2]河北北方学院附属第一医院神经内科,河北张家口075000 [3]河北北方学院附属第一医院胃肠肿瘤外科,河北张家口075000

出　　处：《现代肿瘤医学》2023年第1期109-114,共6页Journal of Modern Oncology

基　　金：河北省张家口市科技计划项目(编号:2021078D);河北省政府资助临床医学优秀人才培养和基础课题研究项目(编号:361009)。

摘　　要：目的:通过术前应用紫杉醇联合卡铂(paclitaxel plus carboplatin,TC)单周新辅助化疗方案、术前应用TC单周新辅助化疗同步联合放疗方案和直接手术治疗在Ⅲ期食管胃结合部腺癌(adenocarcinoma of esophagogastric junction,AEG)诊疗中的应用分析,评价术前新辅助治疗在Ⅲ期AEG治疗中的影像学改变及近期疗效。方法:Ⅲ期AEG患者90例,随机分成直接手术组、TC方案新辅助化疗组(新辅助化疗组)及TC方案新辅助化疗同步联合放疗组(新辅助放化疗组),各30例。评价新辅助化疗组与新辅助放化疗组影像学变化,比较新辅助化疗组与新辅助放化疗组临床分期及病理分期变化情况,另比较三组患者手术R0切除率。结果:新辅助治疗后影像学变化:电子胃镜:新辅助化疗组与放化疗组出现肿瘤较前缩小或消失,部分原发灶处黏膜较前平整,轻微充血变红。CT检查可见原发肿瘤灶显著缩小,浸润的胃壁较前变薄、结构层次较前清楚,周围淋巴结较前缩小和/或数量减少。影像学提示新辅助治疗对AEG治疗效果显著。新辅助治疗后分期变化:新辅助放化疗组较新辅助化疗组患者分期改变明显,差异具有统计学意义(P<0.05)。三组R0切除率情况:新辅助化疗组与新辅助放化疗组R0切除率均高于直接手术组(P_(a)=0.004,P_(b)=0.000),且新辅助放化疗组R0切除率高于新辅助化疗组(P_(c)=0.045)。结论:TC单周方案新辅助化疗和新辅助同步放化疗均能使Ⅲ期AEG患者病灶影像学出现明显改变,肿瘤病灶降期,提高R0切除率,且新辅助同步放化疗组效果要优于新辅助化疗组。TC单周新辅助化疗联合同步放疗方案可推广用于Ⅲ期AEG的新辅助治疗。Objective:To investigate the application of preoperative neoadjuvant chemotherapy regimen of paclitaxel plus carboplation(TC)for single week,preoperative TC for single week combined with radiotherapy and direct surgery in the treatment of stageⅢadenocarcinoma of esophagogastric junction(AEG),and to evaluate the imaging changes and short-term efficacy of preoperative neoadjuvant therapy in stageⅢAEG treatment.Methods:90 patients with stage III AEG were randomly divided into direct surgery group,TC regimen neoadjuvant chemotherapy group,and TC regimen neoadjuvant chemotherapy combined with radiotherapy group,30 cases in each group.The imaging changes in the neoadjuvant chemotherapy group and the neoadjuvant chemoradiotherapy group were evaluated,and the clinical and pathological staging changes in the neoadjuvant chemotherapy group and the neoadjuvant chemoradiotherapy group were compared,and the surgical R0 resection rate was compared among the three groups.Results:Imaging changes after neoadjuvant therapy for electronic gastroscope showed tumors in neoadjuvant chemotherapy group and chemoradiotherapy group shrunk or disappeared,and the mucosa at some primary lesions was smoother than before,slightly congested and turned red.CT examination showed that the primary tumor foci was significantly reduced.The infiltrating gastric wall was thinner than before,and the structure level was clearer than before,and the surrounding lymph nodes were smaller and/or less in number than before.Imaging suggested that neoadjuvant therapy has a significant effect on AEG treatment.Staging changes after neoadjuvant therapy was showed the neoadjuvant chemoradiotherapy group had significant staging changes compared with the neoadjuvant chemotherapy group,and the difference was statistically significant(P<0.05).The R0 resection rate of the three groups:the R0 resection rate of the neoadjuvant chemotherapy group and the neoadjuvant chemoradiotherapy group was higher than that of the direct surgery group(P_(a)=0.004,P_(b)=0.000),and the

关 键 词：新辅助化疗 新辅助放化疗 紫杉醇 卡铂 食管胃结合部腺癌 

分 类 号：R735.2[医药卫生—肿瘤]