胃癌根治术后辅助治疗的临床分析

Clinical Analysis of Postoperative Adjuvant Therapy in Gastric Cancer

摘要: 目的：分析胃癌根治术后辅助治疗的疗效和副作用。方法：2005年1月至2012年9月在本院接受综合治疗的患者，男性94例，女性62例，平均年龄58.2岁(23~84岁，中位58岁)。所有病例均为手术病理证实为胃癌，按AJCC分期第7版标准，IA期7例，IB期7例，IIA期6例，IIB期19例，IIIA25例，IIIB期34例，IIIC期44例，IV期12例，不详2例。156例均采用根治性切除。12例术后未行任何化疗，142例术后接受各种方案的化疗，其中64例采用多西紫杉醇 + 铂类 + 氟尿嘧啶类(DCF)或表阿霉素 + 铂类 + 氟尿嘧啶类(ECF)三药方案，66例采用铂类 + 氟尿嘧啶类两药方案，9例采用口服替吉奥或卡培他滨单药化疗，1例仅采用铂类 + 氟尿嘧啶类腹腔灌注，2例化疗方案不详。有28例接受术后放疗。结果：中位随访36.5月。3年总生存率为53.5%，3年局部控制率为82.0%，3年无远处转移率53.8%。单因素分析显示T分期(T1-3或T4)、N分期(N0-1或N2-3)、术后分期(I-II期或III-IV期)与总生存和局部控制有统计学意义，而淋巴管癌浸润(浸润或否)影响远处转移。另外，在术后化疗方面，采用三药方案的在总生存上优于两药方案(P=0.047)。结论：胃癌总体疗效仍不高，术后化疗采用DCF/ECF三药方案OS可能有优势。

Abstract: Objective: To analyze the response and side effects of postoperative adjuvant therapy in gastric cancer. Methods: From January 2005 to September 2012, 156 patients with gastic cancinoma re-ceived the treatment in our hospital, 94 male, 62 female. The average age is 58.2 years (23 to 84 years, median 58 years). All the cases were pathologically confirmed gastric cancer. According to the 7th edition AJCC staging, IA, 7 cases; IB, 7 cases; IIA, 6 cases; IIB, 19 cases; IIIA, 25 cases; IIIB, 34 cases; IIIC, 44 cases; IV, 12 cases; 2 cases were unknown. All 156 cases have adopted radical resection. 12 cases did not undergo any chemotherapy after surgery; 142 cases received postoperative chemotherapy, 64 cases were treated with docetaxel + platinum + fluorouracil (DCF) or epirubicin + platinum + fluorouracil (ECF) three-drug regimen; 66 cases were treated with platinum + fluorouracil two-drug regimen; 9 cases with oral S1 or capecitabine chemotherapy; one case with only intraperitoneal infusion of platinum + fluorouracil; two cases, unknown chemotherapy regimen. 28 patients received postoperative radiotherapy. Results: The median follow-up was 36.5 months. 3-year overall survival rate was 53.5%; 3-year local control rate was 82.0%; 3-year distant metastasis rate was 53.8%. Univariate analysis showed that T stage (T1-3 or T4), N stage (N0-1 or N2-3), postoperative stage (I-II or III-IV) were statistically significant with local control and overall survival (P < 0.05 for all) and that lymphatic invasion had impact on distant metastasis (P=0.036). In postoperative chemotherapy, the use of three-drug regimen is superior to the two-drug regimen on overall survival (P=0.047). Conclusions: The overall effect of treatment in gastric cancer remains poor. Postoperative chemotherapy using DCF/ECF three-drug regimen might have an advantage on overall survival.