SOX方案在食管胃结合部腺癌辅助化疗中的相关研究

发布时间：2018-04-03 19:24

  本文选题：食管胃结合部腺癌　切入点：辅助化疗　出处：《皖南医学院》2017年硕士论文

【摘要】：目的:胃癌和食管胃结合部肿瘤(Carcinoma of Esophagogastric Junction,CEG)是一种具有高度侵袭性的消化系统恶性肿瘤,是全世界癌症相关死亡第三大常见原因。全世界胃癌的发病率逐渐减少,但CEG的发病率在稳步增加。CEG从病理学角度上主要包含食管下段鳞癌以及食管胃结合部腺癌(Adenocarcinoma of Esophagogastric Junction,AEG)两种类型,有将近50%的患者在初诊时即诊断为局部晚期,且预后不良,尽管行R0根治性切除术后病人的五年生存率也达不到20%。关于胃癌大量的辅助和新辅助治疗已经证明相比于单独手术治疗改善了约15%的生存。关于AEG的治疗方案选择至今仍存在不少争议。本文主要是回顾性分析AEG术后辅助化疗的相关研究,比较SOX(奥沙利铂联合替吉奥)方案与PF(顺铂联合5-氟尿嘧啶)方案治疗AEG根治术后患者的疗效以及安全性,从而探讨更适于AEG患者的化疗方案。方法:回顾性分析2010年10月-2013年10月在解放军第105医院行AEG根治术后病理分期为Ⅲ期,接受SOX方案和PF方案化疗的患者共76例,其中SOX方案组38例,PF方案组38例,比较两组患者的无病生存期(Disease-Free Survival,DFS)、总生存期(Overall Survival,OS)以及化疗不良反应。生存时间采用Kaplan-Meier法和Log rank检验进行生存分析,率的比较采用卡方检验,不良反应分级按照美国国立癌症研究所常见毒性分级标准3.0版(National Cancer Institute Common Toxicity Criteria Version 3.0,NCI-CTC v3.0)进行评估。结果:1.SOX组中位DFS为33.2个月,PF组中位DFS17.8个月,SOX组高于PF组,有显著统计学差异(χ~2=18.918,P0.001)。2.SOX组中位OS为39.3个月,PF组中位OS23.4个月,SOX组高于PF组,有显著统计学差异(χ~2=24.789,P0.001)。3.SOX组与PF组毒副反应主要是骨髓抑制和消化道反应,如白细胞及中性粒细胞减少,贫血,恶心、呕吐,以Ⅰ~Ⅱ度为主。SOX组与PF组白细胞减少发生率分别为44.7%、65.8%,贫血发生率分别为36.8%、55.3%,血小板减低发生率分别为7.9%、10.5%,肝功能损伤发生率分别为15.8%、18.4%,肾功能损伤发生率分别为7.9%、15.8%,以上均无明显统计学差异(P0.05)。两组中性粒细胞减少发生率分别占39.5%、65.8%,有显著统计学差异(χ~2=5.278,P=0.022);两组恶心呕吐发生率分别为42.1%、65.8%,有显著统计学差异(χ~2=4.290,P=0.038)。SOX方案组外周神经系统毒性发生率较PF方案组高,有显著统计学差异(χ~2=10.050,P=0.002),但均在可耐受范围内。结论:SOX作为AEG患者根治术后辅助化疗方案,同PF方案相比,患者的中位DFS及OS均延长,毒副反应均可耐受,具有明显优势,为下一步进行大样本的临床试验提供了依据。
[Abstract]:Objective: carcinoma of Esophagogastric JunctionCegor is a highly invasive malignant tumor of the digestive system and is the third most common cause of cancer-related death in the world.Nearly 50% of the patients were diagnosed locally late at first visit and had poor prognosis, although the 5-year survival rate of patients after R0 radical resection was less than 20%.A large number of adjuvant and neoadjuvant treatments for gastric cancer have been shown to improve survival by about 15% compared to surgery alone.The choice of treatment for AEG is still controversial.The purpose of this study was to retrospectively analyze the related studies of adjuvant chemotherapy after AEG, and to compare the efficacy and safety of SOX (oxaliplatin combined with teguio) regimen and PF- (cisplatin combined with 5-fluorouracil) regimen in the treatment of patients with AEG after radical operation.To explore a more suitable chemotherapy regimen for patients with AEG.Methods: from October 2010 to October 2013, 76 patients were treated with SOX regimen and PF regimen, including 38 cases of SOX regimen group, 38 cases of PF regimen group, and the pathological stage 鈪，

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