胃癌术后辅助化疗两药和三药方案的选择

目的观察性研究胃癌术后辅助化疗中的两药方案（氟尿嘧啶联合铂类）与三药方案（在两药基础上联合蒽环类）对患者预后的影响。方法回顾性分析2004-2008年在上海复旦大学附属中山医院接受上述两药或三药方案进行术后辅助化疗的胃癌患者的临床资料和随访资料．随访终点为死亡或最终随访日（2010年4月30日）。结果共计316例接受过胃癌根治性手术且无远处转移的患者术后4-6周开始接受辅助化疗．化疗方案的选择根据主治医师和患者双方的讨论后决定。两药组210例,三药组106例。其中三药组较两药组年龄略轻（51岁比57岁．P〈0．01）,余基线情况两组间差异无统计学意义（P〉0．05）。中位随访时间47个月．两药组中位无进展生存期16个月,3年总体生存率59．6％：三药组则分别为23个月和64．8％,两组差异无统计学意义（P=0．656和P=0．293）。严重不良反应发生率两药组21．9％（46／210）。三药组30．2％（32／106）。两组差异无统计学意义（P=0．107）。结论胃癌术后辅助化疗中的三药联合方案未显示优于两药方案。

Adjuvant chemotherapy for gastric cancer: more drugs do not mean better efficacy

Objective To compare oncologic outcomes between doublet and triplet adjuvant chemotherapy for gastric cancer patients undergoing radical resection. Methods Patients with gastric cancer receiving adjuvant chemotherapy after radical resection from January 2004 to December 2008 were included. Doublet was defined as 5-FU 750 mg/m2 (days 1-5) or capecitabine 1000 mg/m2(days 1-14) plus cisplatin 60 mg/m2(day 1) or oxaliplatin 130 mg/m2(day 1), while triplets had epirubicin 50 mg/m2 (day 1) added. Chemotherapy was initiated 4-6 weeks after surgery, repeated every three weeks for 6 cycles. Patients were followed-up in the outpatient clinic until death or the most recent follow up (April 30, 2010). Cox proportional-hazard model and Chi-square test were used to test statistical difference. Results A total of 316 patients (210 received doublets, 106 received triplets) had a median follow-up time of 47 months. Seventy-seven patients died at the end of the followup. Two groups were comparable except for age (median age of 57 in doublets, 51 in triplets,P<0.01). The two groups had similar disease-free survival(16 months vs. 23 months, P=0.656) and 3-year overall survival (59.6% vs. 64.8%, P=0.293). There was no significant difference in severe adverse side effects between the two groups (21.9% vs. 30.2%, P=0.107). Conclusion Triplet adjuvant chemotherapy appears not to be associated with superior efficacy than doublet regimen for patients with gastric cancer after radical resection.