| 晚期胃癌不同一线及后线治疗方案的疗效对比分析 |
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| 引用本文： | 张力苹,赵媛媛,余锡贺,王爱井,林 卉,张启周. 晚期胃癌不同一线及后线治疗方案的疗效对比分析[J]. 现代肿瘤医学, 2022, 0(22): 4113-4119. DOI: 10.3969/j.issn.1672-4992.2022.22.017 |
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| 作者姓名： | 张力苹 赵媛媛 余锡贺 王爱井 林 卉 张启周 |
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| 作者单位： | 广东省中西医结合医院肿瘤科,广东 佛山 528200 |
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| 摘 要： | 目的:分析晚期胃癌(advanced gastric cancer, AGC)一线及后线治疗方案的疗效及生存情况,为指导AGC的系统治疗及全程管理提供依据。方法:收集我院肿瘤科2015年01月至2019年12月收治的AGC患者的临床特征、辅助检查资料、治疗相关资料、疗效评估、疾病转归等相关临床资料,建立数据库,分析不同一线及后线治疗方案的疗效,以及不同人群、进行不同线数化疗的患者总生存期(overall survival, OS)的差异。结果:一线治疗总体客观缓解率(objective response rate, ORR)为37.6%,疾病控制率(disease control rate, DCR)为83.9%;二线治疗ORR为9.5%,DCR为44.6%;三线及以上治疗ORR为0%,DCR为15.2%。总体人群一线治疗中位无进展生存(median progression-free survival, mPFS)时间为7.0个月,中位总生存(medianoverall survival,mOS)时间为15.6个月;二线治疗mPFS时间为3.0个月,mOS时间为7.2个月。一线化疗采取含铂方案与含紫杉方案对比,mPFS分别为7.0个月、4.5个月(P=0.041),mOS分别为16.0个月、9.0个月(P=0.061);二线含紫杉方案与含伊立替康方案对比,mPFS分别为2.6个月、4.0个月(P=0.531),mOS分别为7.0个月、6.5个月(P=0.822)。仅进行一线治疗、一线+二线治疗、一线+二线+三线及以上治疗的AGC患者mOS分别为14.0个月、14.0个月及20.0个月,进行三线及以上治疗的患者mOS优于进行一线+二线治疗的患者(P=0.001)。一线方案中采用两药或三药及以上、有无免疫治疗对患者的mPFS及mOS无影响,且二线治疗中有无联合免疫治疗对患者的mPFS及mOS也无影响。结论:含铂双药方案疗效较佳,应作为AGC患者一线治疗的优选方案;二线及后线化疗有效率较低,二线化疗方案紫杉类与伊立替康疗效无差异;在非选择AGC人群中,一线及二线治疗中联合免疫治疗未见改善生存,化疗仍然是基石。
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| 关 键 词： | 晚期胃癌 化疗 无进展生存 总生存 |
Comparison of the efficacy of different first-line and posterior-line treatment regimens for advanced gastric cancer |
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| ZHANG Liping,ZHAO Yuanyuan,YU Xihe,WANG Aijing,LIN Hui,ZHANG Qizhou. Comparison of the efficacy of different first-line and posterior-line treatment regimens for advanced gastric cancer[J]. Journal of Modern Oncology, 2022, 0(22): 4113-4119. DOI: 10.3969/j.issn.1672-4992.2022.22.017 |
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| Authors: | ZHANG Liping ZHAO Yuanyuan YU Xihe WANG Aijing LIN Hui ZHANG Qizhou |
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| Affiliation: | Department of Oncology,Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine,Guangdong Foshan 528200,China. |
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| Abstract: | Objective:To investigate the efficacy and survival time of first-line and posterior-line treatment for advanced gastric cancer (AGC),so as to provide basis for systematic treatment and full treatment management to AGC.Methods:The clinical characteristics,auxiliary examination data,treatment-related data,curative effect evaluation,disease outcome and other related clinical data of patients with AGC admitted to the department of oncology in our hospital from January 2015 to December 2019 were collected,and the database was established to analyze the efficacy of different first-line and posterior-line treatment regimens,as well as the difference of overall survival (OS) time of patients with different groups and different lines of chemotherapy.Results:The objective response rate (ORR) of first-line treatment was 37.6%,and the disease control rate (DCR) was 83.9%.The ORR of second-line treatment was 9.5%,and the DCR was 44.6%.The ORR of third-line and above treatment was 0%,and the DCR was 15.2%.In the total population,the median progression-free survival (mPFS) and median OS (mOS) of the first-line treatment were 7.0 months and 15.6 months,while the mPFS and mOS of the second-line treatment were 3.0 months and 7.2 months respectively.Compared with the regimen containing platinum and taxanes in the first-line chemotherapy,the mPFS was 7.0 months and 4.5 months respectively (P=0.041),mOS was 16.0 months and 9.0 months respectively （P=0.061）.The mPFS of the second-line regimen containing taxanes and irinotecan was 2.6 months and 4.0 months respectively (P=0.531),mOS was 7.0 months and 6.5 months respectively (P=0.822).The mOS of patients with AGC who received only first-line therapy,first-line＋second-line therapy,third-line and more were 14.0,14.0 and 20.0 months,respectively.The mOS time of patients received third-line and more treatment was better than that of patients with first-line＋second-line therapy (P=0.001).In the first-line regimen,chemotherapy with two or three drugs or more,also with or without immunotherapy had no effect on prolonging the mPFS time and mOS time of the AGC patients,and the combination of immunotherapy in the second-line therapy showed no effect on the mPFS and mOS.Conclusion:Platinum-containing doublet chemotherapy is effective and should be used as the optimal regimen for first-line treatment of AGC.The effective rate of second-line and posterior-line chemotherapy is low,and there is no differences between taxanes and irinotecan in the second-line chemotherapy.In non-selected patients with AGC,combined immunotherapy in first-line and second-line treatment did not improve overall survival,and chemotherapeutic drugs were pivotal in AGC patients. |
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| Keywords: | advanced gastric cancer chemotherapy PFS OS |
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