替吉奥分别联合紫杉醇或奥沙利铂一线治疗晚期胃癌的疗效及安全评价

目的对比分析替吉奥联合奥沙利铂或紫杉醇对晚期胃癌的临床化疗效果及安全性分析。方法将晚期胃癌患者分为2组。A组予替吉奥40 mg/m~2联合奥沙利铂130 mg/m~2(n=49),B组予替吉奥40 mg/m~2联合紫杉醇150 mg/m~2(n=40)。结果化疗2个周期,A组缓解率(38. 78%)稍高于B组(37. 50%);化疗3个月后A组缓解率为51. 02%,控制率为71. 43%; B组缓解率为47. 50%,控制率为75. 00%。B组不良反应高于A组(P0. 05)。A组中位无进展生存期(PFS)为4. 3个月,B组的中位PFS为3. 9个月。结论与B组相比,A组短期缓解率更高,不良反应更少,无进展生存期稍长,两组化疗方案近期疗效差异无统计学意义。     

单药替吉奥胶囊治疗老年晚期胃癌的临床观察

目的：观察单药替吉奥胶囊治疗晚期胃癌的临床疗效及毒副反应。方法：选择50例经病理证实的老年晚期胃癌患者,随机分为治疗组32例及对照组18例。治疗组根据体表面积给予替吉奥胶囊治疗,对照组给予营养等最佳支持治疗。每2周期后行影像学检查评价疗效、记录不良反应及随访情况。结果：治疗组32例患者CR(完全缓解)0例,PR(部分缓解)10例,SD(病情稳定)12例,PD(病情进展)10例,临床总缓解率31.3%,临床获益率68.8%。治疗组中位无疾病进展时间及中位生存期分别为5.7及11.5个月,对照组分别为3.1及7.6个月。毒副反应主要为I-III度骨髓抑制、消化道反应、肝功能损伤及手足综合症。结论：单药替吉奥胶囊治疗老年晚期胃癌效果肯定,生活质量高、毒副作用小。     

经皮穿刺微波凝固联合替吉奥治疗胃癌肝转移的疗效观察

目的观察经皮穿刺微波凝固治疗（PMCT）术后联合替吉奥胶囊（S-1）治疗胃癌肝转移的疗效。方法选择本科2009年2月~2012年3月收治的56例胃癌根治术后肝转移患者,分为PMCT术后联合替吉奥组（实验组,n=28）和单用PMCT组（对照组,n=28）。实验组PMCT术后口服替吉奥胶囊每日50mg/m2,连续给药14d,停药7天,共化疗6个疗程。结果实验组和对照组治疗结束时完全缓解分别为64.28%（18/28）和32.14%（9/28）,部分缓解分别为25%（7/28）和21.42%（6/28）,稳定分别为7.14%（2/28）和32.14%（9/28）,有效率89.29%（25/28）和53.57%（15/28）,两组相比均有统计学差异（P〈0.05）。毒副反应主要为骨髓抑制、胃肠道反应等。结论胃癌根治术后肝转移患者PMCT术后联合替吉奥化疗可提高患者术后生存率且毒副反应较轻,是胃癌根治术后伴肝转移有益的辅助治疗方案。     

多西紫杉醇联合卡培他滨与FOLFOX4方案治疗晚期胃癌疗效对比

目的比较多西紫杉醇联合卡培他滨或FOLFOX4方案治疗晚期胃癌的近期疗效及毒副反应。方法52例晚期胃癌的患者随机分为2组,实验组即多西紫杉醇联合卡培他滨治疗组,多西紫杉醇40mg／（m^2,w）d1．d8静脉输注,卡培他滨片每日口服2000mg／m^2每日二次d1—14,21d为1周期：对照组即FOLFOX4方案组,奥沙利铂85mg／m2dl静脉输注,亚叶酸钙200mg／m^2d1-2静脉输注2h,5-Fu400mg／m^2 d1-2快速静点。5-Fu600mg／m2d1-2持续静脉泵入22h,每14d重复,28d为1周期。均化疗2个周期以上,观察2纽药物的近期疗效及毒副反应。结果实验组CR2例．PR12例,有效率53．8％;对照组CR1例,PR12例,有效率50％,两组疗效无显著性差异。实验组与对照组的骨髓抑制及胃肠道反应发生率均较为常见．两组之间发生率无统计学差异。手足综合征发生率实验组明显高于对照组,但其多为Ⅰ-Ⅱ度,患者多能耐受,对生活质量影响轻微。对照组的毒副反应主要是外周神经毒性及腹泻,发生率显著高于实验组,两组数据比较在统计学上有显著性差异。结论多西紫杉醇联合卡培他滨治疗晚期胃癌的疗效确切,毒性反应发生程度轻,对晚期胃癌治疗有着积极的意义。     

替吉奥联合阿帕替尼治疗晚期胰腺癌的疗效分析

目的 探讨替吉奥联合阿帕替尼治疗晚期胰腺癌的临床疗效。方法 选取2016年5月~2018年5月我院收治的100例晚期胰腺癌患者作为研究对象,按照数字随机分为对照组和研究组,每组50例。对照组采用阿帕替尼治疗,研究组采用替吉奥联合阿帕替尼治疗,比较两组PR、PD及化疗后血常规、肝功、不良反应情况。结果 研究组PR、SD分别为46.00%、28.00%,多于对照组的26.00%、6.00%,差异有统计学意义（P＜0.05）;研究组PD占26.00%,少于对照组的68.00%,差异有统计学意义（P＜0.05）。研究组白细胞减少、中性粒细胞减少、血小板减少、贫血、乏力、厌食、氨基转移酶升高、腹泻均低于对照组,差异有统计学意义（P＜0.05）;研究组5个月、10个月、15个月的无进展生存率,均高于对照组,差异有统计学意义（P＜0.05）。结论 替吉奥联合阿帕替尼治疗晚期胰腺癌有利于改善患者的临床症状,降低不良反应发生率,延长患者生命。     

伊利替康联合替吉奥在晚期结直肠癌治疗的临床研究

目的 评价晚期结直肠癌患者采用伊立替康联合替吉奥治疗的临床疗效。方法 选取2015年4月~2017年12月我院肿瘤科收治的60例晚期初治结直肠癌患者作为研究对象,根据治疗方案的不同分为联合治疗组（32例）和对照组（28例）。对照组采用伊立替康治疗方案,在对照组基础上联合治疗组联合替吉奥治疗方案,比较两组的不良反应发生率及疗效情况。结果 治疗后,联合治疗组的临床有效率高于对照组,差异有统计学意义(P＜0.05);两组患者的主要不良反应比较,联合治疗组白细胞减少及胃肠道反应发生率较对照组降低,差异具有统计学意义(P＜0.05)。结论 晚期结直肠癌患者采用伊立替康联合替吉奥治疗方案优于单独采用伊立替康治疗方案,提高临床治疗的有效率,降低白细胞减少及胃肠道等不良反应的发生率。     

替吉奥单药治疗晚期消化系统肿瘤的护理

目的 总结晚期消化系统肿瘤患者口服化疗药物替吉奥的护理体会.方法 对8例患晚期消化系统肿瘤患者口服替吉奥化疗,观察不良反应,总结护理问题及护理措施.结果主要不良反应为恶心、呕吐,不良反应分级多为I度-II度.结论胃肠道反应除了药物本身因素外,患者化疗前的心态也可能存在相关性.化疗前的心理护理及宣教很重要,能有效减少不良反应的发生.     

S-1 monotherapy as second line chemotherapy in advanced gastric cancer patients previously treated with cisplatin/infusional fluorouracil

The treatment choice of advanced gastric carcinoma after failure from first-line therapy is quite limited. To evaluate the efficacy and toxicity of S-1 monotherapy in patients with advanced gastric cancer after failure of first line cisplatin and fluorouracil combination (CF). S-1 monotherapy as a second line treatment was given to the patients who had failed to CF combination in SC-101 study. The efficacy and toxicity of S-1 monotherapy were evaluated exploratory. The results indicated that forty-one patients received S-1 as a second line therapy after disease progression. The overall response rate and disease control rate were 14.6% and 41.5%, respectively. The median progression free survival (PFS) was 5.1 months (ange: 2.9~6.2 month). The median overall survival time was 6.4 months. The survival rates at 6 month and 1 year were 56% and 7.3%, respectively. Grade 3/4 adverse events were uncommonly occurred, including anemia (2.4%), neutropenia (2.4%), thrombocytopenia (4.9%) and rash (2.4%). There were no unexpected or life-threatening toxicities. Only one patient experienced dose reduction due to grade 3 rash. In conclusion, S-1 monotherapy provided a mild response rate and overall survival, and a favorable toxicity profile in the second line setting after the first line failure to cisplatin and fluorouracil combination.     

S-1 monotherapy as second line chemotherapy in advanced gastric cancer patients previously treated with cisplatin/infusional fluorouracil

The treatment choice of advanced gastric carcinoma after failure from first-line therapy is quite limited. To evaluate the efficacy and toxicity of S-1 monotherapy in patients with advanced gastric cancer after failure of first line cisplatin and fluorouracil combination (CF). S-1 monotherapy as a second line treatment was given to the patients who had failed to CF combination in SC-101 study. The efficacy and toxicity of S-1 monotherapy were evaluated exploratory. The results indicated that forty-one patients received S-1 as a second line therapy after disease progression. The overall response rate and disease control rate were 14.6% and 41.5%, respectively. The median progression free survival (PFS) was 5.1 months (range: 2.9~6.2 month). The median overall survival time was 6.4 months. The survival rates at 6 month and 1 year were 56% and 7.3%, respectively. Grade 3/4 adverse events were uncommonly occurred, including anemia (2.4%), neutropenia (2.4%), thrombocytopenia (4.9%) and rash (2.4%). There were no unexpected or life-threatening toxicities. Only one patient experienced dose reduction due to grade 3 rash. In conclusion, S-1 monotherapy provided a mild response rate and overall survival, and a favorable toxicity profile in the second line setting after the first line failure to cisplatin and fluorouracil combination.     

HtrA1, a potential predictor of response to cisplatin-based combination chemotherapy in gastric cancer

Catalano V, Mellone P, d’Avino A, Shridhar V, Staccioli M P, Graziano F, Giordani P, Rossi D, Baldelli A M, Alessandroni P, Santini D, Lorenzon L, Testa E, D’Emidio S, De Nictolis M, Muretto P, Fedeli S L & Baldi A
(2011) Histopathology 58 , 669–678
HtrA1, a potential predictor of response to cisplatin‐based combination chemotherapy in gastric cancer Aims: HtrA1 is a member of the HtrA (high‐temperature requirement factor A) family of serine proteases. HtrA1 plays a protective role in various malignancies due to its tumour suppressive properties. The aim of this study was to determine HtrA1 expression as a predictor of chemoresponse in patients with advanced gastric cancer. Methods and results: HtrA1 expression was determined by immunohistochemistry on specimens of primary gastric cancer from 80 patients treated consecutively with cisplatin‐based combination chemotherapy. Response to chemotherapy was assessed according to Response Evaluation Criteria in Solid Tumours (RECIST) criteria. Our population consisted of males/females [51/29; median age 64 years (range 32–82)]. A complete or partial response was observed in 71.4% [95% confidence interval (CI) 54.7–88.2], 66.7% (95% CI 47.8–85.5) and 28.6% (95 CI 11.8–45.3) of tumours showing high, medium and low HtrA1 expression, respectively. A statistically significant association between HtrA1 expression and the clinical response was observed (P = 0.002). The median overall survival for patients with high/medium expression was 17 months compared to 9.5 months for patients with low HtrA1 expression (P = 0.037). Conclusions: Identification of HtrA1 in gastric cancer prior to chemotherapy indicates that levels of HtrA1 could be used to predict response to platinum‐based combination therapies. Further assessment of HtrA1 expression is highly warranted in large, prospective studies.     

卡培他滨联合顺铂一线治疗HER2阴性的晚期胃癌后卡培他滨维持的疗效及安全性

目的:研究卡培他滨联合顺铂(XP方案)一线治疗HER2阴性的晚期胃癌后给予卡培他滨维持化疗的疗效及安全性.方法:82例初治的HER2阴性的晚期胃癌患者一线方案采用XP方案.每2周期化疗后进行疗效评价.最多6个周期化疗后疗效评价为无疾病进展的患者共59例,随机分为两组(A,B组),A组(n=30)给予卡培他滨单药维持化疗(1000 mg/m2,2次/d,d1～14,3周为1周期),持续至疾病进展或患者出现不能耐受的毒副作用为止.B组(n=29)仅接受定期随访观察.结果:82例患者共接收416周期的初始化疗,经初始化疗后均可评价疗效,总有效率(response rate,RR)为48.78％,疾病控制率(disease control rate,DCR)为71.95％.A组RR和DCR分别为26.67％,76.67％,均高于B组(RR和DCR分别为0.00％,37.93％,P<0.05).维持化疗组中位疾病进展时间(time to progress,TTP)7.9个月较B组5.3个月延长(P<0.05).A组和B组中位总生存期(overall survival,OS)分别为14.8,13.2个月,差异无统计学意义(P>0.05).维持化疗期间主要不良反应有骨髓抑制、恶心呕吐、腹泻、周围神经毒性、黏膜炎、手足综合征等,经对症治疗后均有好转,无治疗相关性死亡.结论:XP方案一线治疗HER2阴性的晚期胃癌后单药卡培他滨维持,可提高有效率、疾病控制率,延长疾病进展时间,且不良反应轻,值得进一步研究和临床推广应用.     

晚期胃癌的腹腔热灌注联合全身静脉化疗临床疗效的观察

目的探讨合并腹腔和肝脑脏器转移的晚期胃癌患者,腹腔热灌注化疗联合全身静脉化疗的临床疗效。方法 23例晚期胃癌患者分为2组,实验组10例行腹腔热灌注化疗联合全身静脉化疗,对照组13例仅行单纯静脉化疗。比较2组患者的不良反应和并发症、生存情况、KPS评分情况。结果实验组总生存期较对照组延长,差异有统计学意义(P=0.003)。2组治疗前的生存质量KPS评分没有统计学差异(P=0.835),2组患者的不良反应及并发症发生率无统计学差异。结论合并腹腔和肝脑脏器转移的晚期胃癌患者,行腹腔热灌注化疗联合全身静脉化疗较单纯全身静脉化疗,可能有助于改善其生存质量和延长生存期。     

高龄胃癌合并2型糖尿病患者的围手术处理

目的探讨高龄胃癌合并2型糖尿病患者的围手术处理。方法对2000-2010年间108例高龄胃癌合并糖尿病患者围手术处理情况进行回顾性分析。结果 108例病人均作胃癌限期手术,术后并发症发生率为36.1%,其中切口感染19例（17.6%）,肺部感染12例（11.1%）,吻合口漏4例（3.7%）,泌尿系感染2例（1.9%）,高渗性昏迷1例（0.9%）,死亡1例（0.9%）。术后患者平均住院时间为19d。结论控制血糖和选择合理的术式、手术时机,高龄胃癌并糖尿病患者可顺利度过围手术期,并取得良好的手术疗效。     

Surgical outcome of synchronous second primary cancer in patients with gastric cancer

PURPOSE: In order to improve the likelihood of curative and safe gastric surgery, this study investigated the clinical features and surgical outcomes of gastric cancer with a synchronous cancer. PATIENTS AND METHODS: The clinicopathological data of 10,090 gastric cancer patients at Samsung Medical Center from September 1994 to December 2006 were retrospectively analyzed. Of them, 90 patients with gastric cancer and a synchronous second primary cancer underwent simultaneous surgery for gastric cancer and second primary cancer. The clinicopathological characteristics of the patients, surgical outcome, and prognosis were examined. RESULTS: The most common synchronous second primary cancer was colorectal cancer (37 patients), followed by hepatocellular carcinoma (13 patients), renal cell carcinoma (11 patients), and pancreatic carcinoma (5 patients). The incidence of a second primary cancer in the gastric cancer patients was higher than the incidence in the general population. Stage I gastric cancer patients had more synchronous cancers than stage II patients (59 vs. 31). Postoperative complications were encountered in 7 patients. Four patients underwent reoperation. Two patients died from hepatic failure and leakage of esophagojejunal anastomosis. The 5-year survival rate of stage I and II gastric cancer was 61% and 39%, respectively. CONCLUSION: Since gastric cancer patients with a synchronous second primary cancer are not rare, the possibility of synchronous cancers in gastric cancer patients should be considered. The prognosis of early stage gastric cancer patients with a synchronous second primary cancer was influenced more by the presence of the second primary cancer than by the gastric cancer itself.     

康莱特注射液对胃癌患者细胞凋亡、增殖及T细胞亚群的影响

目的：探讨康莱特对胃癌细胞凋亡对增殖及胃癌患者T细胞亚群的影响。方法：进展期胃癌患者30例，随机分为3组（每组各10例）：A组（对照组）：手术前后常规给予全胃肠外营养（total parenteral nutrition,TPN)治疗；B组（康莱特治疗组）：术前5d及术后9d，给予康莱特注射液200mL/d静脉滴入加常规TPN治疗；C组（化疗组）：术前给予5d化疗，甲酰四氢叶酸钙（calcium folinatefor,CF)200mg及5氟脲嘧啶（5－FU）750mg/d静脉滴注加常规TPN治疗。分别于治疗前及术后1d,5d及10d，采集外周静脉血，应用免疫荧光法检测CD3^ 、CD4^ 、CD8^ T细胞亚群。手术中取胃癌病理组织，用末端转移酶介导的dUTP切口末端标记法和免疫组织化学染色法检测胃癌细胞的凋亡（AI）与增殖（PI）及二者之比（AI／PI）。结果：B组与C组相比较，胃癌细胞的AI、PI及AI／PI，无显著差异（P＞0．05）；B组与A组相比较，上 3种指标则具有显著差异（P＜0．01）。治疗前3组CD3^ 、CD4^ 、CD8^ T细胞亚群的百分率无显著差异（P＞0．05）；术后1d,5d3组CD3^ 、CD4^ 、CD8^ T细胞亚群的百分率差异显著（P＜0．01）；术后10d,CD3^ 、CD4^ 、CD8^ T细胞亚群的百分率，B组与A组以及B组与C组相比较，差异性分别为显著（P＜0．05）及非常显著（P＜0．01）。结论：康莱特可明显促进胃癌细胞凋亡和抑制其增殖，有助于提高围手术期患者的免疫功能。