洛铂新辅助联合腹腔灌注化疗治疗进展期胃癌的临床疗效
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摘要
目的探讨洛铂新辅助联合术毕腹腔灌注化疗治疗进展期胃癌的临床疗效及不良反应。方法回顾性分析本院胃肠外科2015年1月至2016年1月收治并行洛铂新辅助联合术毕腹腔灌注化疗的进展期胃癌患者30例(化疗组)与直接行手术治疗的进展期胃癌患者35例(对照组)的临床资料。化疗组患者术前接受新辅助化疗方案,对照组患者直接接受手术治疗;两组患者术后均行全身静脉化疗6个周期。结果两组年龄、性别、BMI、腹痛、黑便、腹水、合并症等一般情况比较(P>0.05);化疗组行根治性切除术20例,较对照组多(P<0.05),姑息性切除术8例,探查术1例,胃空肠吻合术1例,对照组分别为14、15、3、3例。化疗组淋巴结清扫数及转移数分别为(12.97±8.39,4.83±2.77)枚,对照组为(19.29±9.19,8.43±5.70)枚,两组相比较(P <0.05);两组术后12个月、24个月肿瘤复发及转移情况比较(P<0.05)。化疗组2年生存率为93.33%(28/30)例,对照组为68.58%(24/35)例,两组相比(P<0.05);主要毒副反应为骨髓抑制及胃肠道反应,两组相比(P>0.05)。结论采用洛铂新辅助联合腹腔灌注化疗治疗进展期胃癌具有一定的有效性及安全性,值得临床推广应用。
Objective To explore the clinical effect of neoadjuvant chemotherapy combined with intraperitoneal perfusion of lobaplatin on advanced gastric cancer and the adverse effects.Methods A retrospective analysis was made to the clinical data of 30 cases with advanced gastric cancer in chemotherapy group receiving eoadjuvant chemotherapy combined with intraperitoneal perfusion of lobaplatin before surgical treatment and 35 cases in control group receiving surgical treatment directly;systemic chemotherapy for 6 courses was performed on cases in both groups after surgical treatment.Results There existed no differences in general conditions,including age,gender,BMI,abdominal pain,melena,ascites and complications,between the cases in the 2 groups(P>0.05);radical resection was made in 20 cases in chemotherapy group and 14 cases in control group(P<0.05),palliative resection in 8 cases in chemotherapy group and 15 cases in control group,probing in 1 case and 3 cases in control group and gastrojejunostomy in 1 case in chemotherapy group and 3 cases in control group;there existed statistical differences in the numbers of lymph node dissection and metastasis between chemotherapy group and control group[(12.97±8.39,4.83±2.77)vs(19.29±9.19,8.43±5.70)];the 2-year survival rate was 93.33%(28/30)in chemotherapy group while that in control group was68.58%(24/35)(P<0.05);the main adverse effects were bone marrow suppression and gastrointestinal reaction,the difference between the 2 groups was of statistical significance(P<0.05).Conclusions Neoadjuvant chemotherapy combined with intraperitoneal perfusion of lobaplatin is of certain effect and safety on advanced gastric cancer and is worthy of wider clinical application.
Objective To explore the clinical effect of neoadjuvant chemotherapy combined with intraperitoneal perfusion of lobaplatin on advanced gastric cancer and the adverse effects.Methods A retrospective analysis was made to the clinical data of 30 cases with advanced gastric cancer in chemotherapy group receiving eoadjuvant chemotherapy combined with intraperitoneal perfusion of lobaplatin before surgical treatment and 35 cases in control group receiving surgical treatment directly;systemic chemotherapy for 6 courses was performed on cases in both groups after surgical treatment.Results There existed no differences in general conditions,including age,gender,BMI,abdominal pain,melena,ascites and complications,between the cases in the 2 groups(P>0.05);radical resection was made in 20 cases in chemotherapy group and 14 cases in control group(P<0.05),palliative resection in 8 cases in chemotherapy group and 15 cases in control group,probing in 1 case and 3 cases in control group and gastrojejunostomy in 1 case in chemotherapy group and 3 cases in control group;there existed statistical differences in the numbers of lymph node dissection and metastasis between chemotherapy group and control group[(12.97±8.39,4.83±2.77)vs(19.29±9.19,8.43±5.70)];the 2-year survival rate was 93.33%(28/30)in chemotherapy group while that in control group was68.58%(24/35)(P<0.05);the main adverse effects were bone marrow suppression and gastrointestinal reaction,the difference between the 2 groups was of statistical significance(P<0.05).Conclusions Neoadjuvant chemotherapy combined with intraperitoneal perfusion of lobaplatin is of certain effect and safety on advanced gastric cancer and is worthy of wider clinical application.
引文
[1]SIEGEL R L,MILLER K D,JEMAL A.Cancer statistics,2015.[J].Ca A Cancer Journal for Clinicians,2010,60(5):277-300.
[2]HIGUCHI K,PHAN A,AJANI J A.Gastric cancer:Advances in adjuvant and adjunct therapy[J].Current Treatment Options in Oncology,2003,4(5):413-419.
[3]季加孚.胃癌外科治疗研究现状与发展趋势[J].医学研究杂志,2008,37(1):4-4.
[4]俞斐,崔冉,朱方,等.白蛋白结合型紫杉醇联合洛铂与顺铂治疗晚期非小细胞肺癌临床疗效比较[J].药学与临床研究,2014,22(6):536-538.
[5]FREI E.Clinical cancer research:An embattled species[J].Cancer,1982,50(10):1979.
[6]TAKESHITA K,LIU Y,ISHIBASHI H,et al.Laparoscopic Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosisfrom Gastric Cancer:Its Beneficial Effects on Reduction and Exact Evaluation of the Peritoneal Cancer Index.[J].American Surgeon,2017,83(11):1315.
[7]孙燕,石远凯.临床肿瘤内科手册[M].5版.北京:人民卫生出版社,2007:142-145.
[8]季加孚,季鑫.胃癌新辅助化疗的现状与展望[J].中国肿瘤临床,2012,39(20):1458-1461.
[9]MCKEAGE M J.Lobaplatin:a new antitumour platinum drug[J].Expert Opinion on Investigational Drugs,2001,10(1):119.
[10]PUTTER H.Perioperative Chemotherapy versus Surgery Alone for Resectable Gastroesophageal Cancer[J].The Journal of Evidence-Based Medicine,2008,355(1):11.
[11]黄万中,蒋华,刘燕文,等.紫杉醇腹腔灌注化疗联合LV/5-Fu/OXA静脉用药治疗晚期胃癌的疗效及安全性[J].实用医学杂志,2010,26(17):3212-3214.
[12]BANG Y J,XU R H,CHIN K,et al.Olaparib in combination with paclitaxel in patients with advanced gastric cancer who have progressed following first-line therapy(GOLD):a double-blind,randomised,placebo-controlled,phase 3 trial[J].Lancet Oncology,2017.
[13]ZHOU K,WEN F,ZHANG P,et al.Efficacy and cost-effectiveness of second-line chemotherapy in elderly patients with advanced gastric cancer[J].Clinical&Translational Oncology,2017,19(9):págs.1117-1124.
[14]XIE H,DIGESTION D O.Effect comparison between modified folfox6 plan and SOX plan in treatment of advanced gastric cancer patients with neoadjuvant chemotherapy[J].Journal of Clinical Medicine in Practice,2018.
[15]PUTTER H.Perioperative Chemotherapy versus Surgery Alone for Resectable Gastroesophageal Cancer[J].The Journal of Evidence-Based Medicine,2008,355(1):11.
[16]谭永刚,耿东华,苏拓,等.奥沙利铂联合氟尿嘧啶和亚叶酸钙行新辅助化疗治疗进展期胃癌的临床疗效研究[J].中国全科医学,2012,15(17):1937-1939.
[17]崔海滨,张维,白希永,等.进展期胃癌新辅助化疗的临床疗效及安全性研究的meta分析[J].实用医学杂志,2014(9):1472-1475.
[18]李翔.紫杉醇腹腔灌注化疗治疗胃癌恶性腹腔积液的临床研究[J].江西医药,2015(5):390-393.
[2]HIGUCHI K,PHAN A,AJANI J A.Gastric cancer:Advances in adjuvant and adjunct therapy[J].Current Treatment Options in Oncology,2003,4(5):413-419.
[3]季加孚.胃癌外科治疗研究现状与发展趋势[J].医学研究杂志,2008,37(1):4-4.
[4]俞斐,崔冉,朱方,等.白蛋白结合型紫杉醇联合洛铂与顺铂治疗晚期非小细胞肺癌临床疗效比较[J].药学与临床研究,2014,22(6):536-538.
[5]FREI E.Clinical cancer research:An embattled species[J].Cancer,1982,50(10):1979.
[6]TAKESHITA K,LIU Y,ISHIBASHI H,et al.Laparoscopic Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosisfrom Gastric Cancer:Its Beneficial Effects on Reduction and Exact Evaluation of the Peritoneal Cancer Index.[J].American Surgeon,2017,83(11):1315.
[7]孙燕,石远凯.临床肿瘤内科手册[M].5版.北京:人民卫生出版社,2007:142-145.
[8]季加孚,季鑫.胃癌新辅助化疗的现状与展望[J].中国肿瘤临床,2012,39(20):1458-1461.
[9]MCKEAGE M J.Lobaplatin:a new antitumour platinum drug[J].Expert Opinion on Investigational Drugs,2001,10(1):119.
[10]PUTTER H.Perioperative Chemotherapy versus Surgery Alone for Resectable Gastroesophageal Cancer[J].The Journal of Evidence-Based Medicine,2008,355(1):11.
[11]黄万中,蒋华,刘燕文,等.紫杉醇腹腔灌注化疗联合LV/5-Fu/OXA静脉用药治疗晚期胃癌的疗效及安全性[J].实用医学杂志,2010,26(17):3212-3214.
[12]BANG Y J,XU R H,CHIN K,et al.Olaparib in combination with paclitaxel in patients with advanced gastric cancer who have progressed following first-line therapy(GOLD):a double-blind,randomised,placebo-controlled,phase 3 trial[J].Lancet Oncology,2017.
[13]ZHOU K,WEN F,ZHANG P,et al.Efficacy and cost-effectiveness of second-line chemotherapy in elderly patients with advanced gastric cancer[J].Clinical&Translational Oncology,2017,19(9):págs.1117-1124.
[14]XIE H,DIGESTION D O.Effect comparison between modified folfox6 plan and SOX plan in treatment of advanced gastric cancer patients with neoadjuvant chemotherapy[J].Journal of Clinical Medicine in Practice,2018.
[15]PUTTER H.Perioperative Chemotherapy versus Surgery Alone for Resectable Gastroesophageal Cancer[J].The Journal of Evidence-Based Medicine,2008,355(1):11.
[16]谭永刚,耿东华,苏拓,等.奥沙利铂联合氟尿嘧啶和亚叶酸钙行新辅助化疗治疗进展期胃癌的临床疗效研究[J].中国全科医学,2012,15(17):1937-1939.
[17]崔海滨,张维,白希永,等.进展期胃癌新辅助化疗的临床疗效及安全性研究的meta分析[J].实用医学杂志,2014(9):1472-1475.
[18]李翔.紫杉醇腹腔灌注化疗治疗胃癌恶性腹腔积液的临床研究[J].江西医药,2015(5):390-393.