周剂量紫杉醇联合奥沙利铂二线治疗晚期胃癌23例

目的:观察周剂量紫杉醇联合奥沙利铂二线治疗晚期胃癌的疗效和不良反应.方法:收集 2006-07-01/2008-01-31我科以周剂量紫杉醇联合奥沙利铂治疗一线化疗失败的晚期胃癌患者23例,给予紫杉醇70 mg/m2,静脉滴注1 h,第1、8、15天;奥沙利铂100 mg/m2,静脉滴注2 h,第2天,每28天为1个周期.每例患者治疗至少2个周期,2个周期化疗完成后4 wk评价疗效.结果:在可评价疗效的23例患者中,完全缓解(CR)0例,部分缓解(PR)8例(34.8%),疾病稳定(SD)8例(34.8%),疾病进展(PD)7例(30.4%);总有效率(CR+PR)34.8%,95%CI为16%-57%;临床获益者(CR+PR+SD)共16例(69.6%),95%CI为47%-87%.平均肿瘤进展时间(TTP)为3.93±1.47 mo.不良反应主要为脱发、骨髓抑制和外周神经毒性.结论:周剂量紫杉醇联合奥沙利铂二线治疗晚期胃癌疗效好,不良反应可耐受.     

紫杉醇联合顺铂或奥沙利铂治疗晚期胃癌疗效比较

2000年以来,我们采用紫杉醇(TAX) 顺铂(DDP)或TAX 奥沙利铂(TL)治疗晚期胃癌43例．并观察比较两种方案的疗效与不良反应。现报告如下。     

紫杉醇联合奥沙利铂治疗胃癌21例

[目的]观察紫杉醇联合奥沙利铂治疗胃癌的疗效。[方法]将胃癌患者分为3组,分别采取奥沙利铂联合5-氟尿嘧啶(5-FU)、紫杉醇联合5-Fu及紫杉醇联合奥沙利铂治疗,观察治疗效果和不良反应。[结果]奥沙利铂联合5-Fu、紫杉醇联合5-Fu及紫杉醇联合奥沙利铂组治疗的总有效率分别为35.29%、36.84%和52.38%,后组与前2组比较P0.05;不良反应主要是血液学毒性、恶心呕吐、末梢神经感觉异常及脱发。[结论]紫杉醇联合奥沙利铂治疗胃癌疗效明显,不良反应在耐受范围之内,安全性好,值得临床推广应用。     

紫杉醇脂质体联合奥沙利铂、5-氟尿嘧啶治疗晚期食管癌的疗效

食管癌是一种常见的恶性肿瘤,由于其早期诊断困难,一般患者在出现进食梗阻等症状时才来医院就诊,然而此时多数已达中晚期,延误最佳治疗时机〔1〕。在食管癌常用的化疗方案中,顺铂(DPP)与5-氟尿嘧啶(5-Fu)组成的PF方案是对食管癌有效的一线方案〔2〕,对食管癌治疗的有效率约为50%～60%。但对于应用PF方案后的失败病例和复发病例,目前补救方案较少,有效率也不高,因此深入探索更为有效的化疗方案,对于提高晚期食管癌的治疗疗效尤为关键。本文采用紫杉     

紫杉醇、奥沙利铂联合5-氟尿嘧啶/亚叶酸钙治疗晚期胃癌42例临床观察

目的评价紫杉醇（PTX）、奥沙利铂（OXA）联合5-氟尿嘧啶（5-Fu）/亚叶酸钙（CF）治疗晚期胃癌的临床疗效。方法选择晚期胃癌患者42例,所有患者采用PTX 80 mg/m^2,第18、天,静滴3 h;OXA65 mg/m^2,第1、8天,静滴2 h;CF 100 mg,第1～5天,静滴2 h;5-Fu500 mg/m^2,第1～5天,静滴4～6 h。4周为一个周期,所有患者化疗至少接受两个周期。观察临床疗效、肿瘤进展时间（mTTP）、生存期（mOS）、1 a存活率、临床受益反应（CBR）率及毒副反应。结果 42例患者治疗总有效率为61.9%,中位mTTP 7.8个月,中位mOS 11个月,1 a存活率为45.7%,CBR率76.2%,主要毒副反应为脱发、恶心呕吐、周围神经毒性、骨髓抑制,大部分为Ⅰ、Ⅱ级,患者可以耐受。结论 PTX、OXA联合5-Fu/CF方案治疗晚期胃癌具有良好的疗效和耐受性。     

多西紫杉醇奥沙利铂联合卡培他滨治疗晚期胃癌66例疗效观察

目的观察TXELOX（多西紫杉醇奥沙利铂联合卡培他滨）方案治疗晚期胃癌的近期疗效及毒副反应。方法 66例晚期胃癌（Ⅲ~Ⅳ期）使用TXELOX方案：多西紫杉醇（TAT 75 mg/m2）静脉滴注1 h,第1天,使用TAT前用地塞米松预防过敏反应及体液潴留;奥沙利铂（OXA）135 mg/m2,静脉滴注2 h,第2天,用OXA前及当日忌食生冷及接触冷物体;卡培他滨（CAP）800 mg/m2,第1~14日口服,2次/d,该方案每3周为一周期,至少完成3个周期以上,最多6个周期。结果总有效率（CR＋PR）为66.7%,中位疾病进展时间（TTP）为9.7个月,中位总生存期（OS）为13.4个月;主要的毒副反应为手足综合征及神经感觉异常,其次为骨髓抑制及消化道反应。结论 TXELOX方案在晚期胃癌近期疗效较好,不良反应轻微,耐受性较好,该方案值得临床进一步推广和使用。     

替吉奥联合奥沙利铂与FOLFOX6方案治疗晚期胃癌的疗效对比

目的观察替吉奥联合奥沙利铂治疗晚期胃癌的临床疗效、毒副反应及对免疫功能的影响。方法 62例病理学或细胞学确诊的晚期胃癌患者随机分为2组,试验组31例患者给予替吉奥联合奥沙利铂方案,对照组31例患者给予FOLFOX6或改良FOLFOX6方案,两组患者均为2个周期治疗后评价疗效、临床获益、毒副反应,并应用流式细胞仪检测CD3+、CD4+、CD8+、CD19+细胞的百分率。结果试验组与对照组客观缓解率分别为46.7%、43.3%,两组比较无统计学差异(P>0.05)。临床受益率试验组为66.7%,对照组为36.7%,两组间有统计学差异(P<0.05)。两方案主要的毒副反应为骨髓抑制、胃肠道反应、神经毒性、肝肾功能损伤等,大多数为Ⅰ～Ⅱ级不良反应,仅在呕吐反应方面对照组高于治疗组(P<0.05),其余毒性反应两组比较均无统计学差异(P>0.05)。免疫功能方面,CD4+、CD4+/CD8+细胞,试验组与对照组化疗后均较化疗前升高(P<0.05),且两组比较差异有统计学差异(P<0.05);CD3+、CD8+、CD19+细胞试验组与对照组化疗前后均无明显变化。结论替吉奥联合奥沙利铂方案治疗晚期胃癌安全、有效,患者细胞免疫功能提高,耐受性好,且应用方便,值得临床推广。     

卡培他滨联合奥沙利铂治疗老年性胃癌

目的 评价卡培他滨联合奥沙利铂方案治疗老年性胃癌的疗效及不良反应.方法 将2003年1月至2006年12月78例老年性胃癌患者随机分为治疗组(卡培他滨联合奥沙利铂)及对照组(5-Fu联合奥沙利铂及亚叶酸钙),每组39例.治疗组奥沙利铂130 mg/m2静脉滴注2h,第1天口服希罗达化疗2 000 mg/m2,每天分2次...     

奥沙利铂联合化疗方案在进展期胃癌老年患者术后辅助化疗中的价值

目的评价以奥沙利铂为基础的联合化疗方案治疗进展期胃癌的疗效和安全性,并探讨在65岁以上患者术后辅助化疗中的价值。方法回顾性分析已做胃癌手术的288例进展期胃癌患者临床资料,其中102例为≥65岁的老年患者。分为4组并对他们进行术后化疗。根据化疗方案的情况分为经典ECF化疗方案的1组(作为对照组)和以奥沙利铂为基础的3种标准化疗方案分的2,3,4组。分析4组患者的3年生存率(3y-SR)和总生存期(OS)及治疗期间的毒副反应。结果在186例中青年组中(<65岁患者),1、2、3和4组的3y-SR分别为62.6%、55.4%、、54.1%和72.2%,中位OS分别为31.2、30.2、31.3和32.2个月。各方案组间3y-SR、OS差异均无统计学意义(P>0.05)。在102例老年组(≥65岁患者)中,1、2、3和4组的3年生存率分分别为67.6%、88.7%、73.5%和91.1%,中位OS分别为29.5、33.2、31.3和34.2个月。2,3,4方案组间3ySR、OS差异均无统计学意义(P>0.05)。1方案组与2,3,4各方案组间3y-SR,OS差异显著(P<0.05)。2,3,4方案组间Ⅲ、Ⅳ级不良反应发生率差异无统计学意义(P>0.05),1方案组与2,3,4各方案组间Ⅲ、Ⅳ级不良反应发生率差异显著(P<0.05)。结论以奥沙利铂为基础的3种方案临床疗效及安全性优于经典ECF方案,且比经典ECF方案更能提高3y-SR和延长患者生存期。     

替吉奥胶囊联合奥沙利铂治疗晚期胃癌的临床观察

［摘要］　目的　观察替吉奥胶囊联合奥沙利铂治疗晚期胃癌的疗效及不良反应。方法　将60例晚期胃癌患者随机分为治疗组30例和对照组30例。治疗组给予替吉奥胶囊联合奥沙利铂方案治疗,对照组给予奥沙利铂联合亚叶酸钙和5-氟尿嘧啶方案治疗,全部患者均接受至少4个周期的化疗。结果　治疗组完全缓解0例,部分缓解19例,稳定10例,进展1例;对照组完全缓解0例,部分缓解9例,稳定17例,进展4例。两组主要不良反应为血液学毒性、胃肠道反应和神经系统毒性,治疗组的不良反应发生率明显低于对照组(P<0.05）。结论　替吉奥胶囊联合奥沙利铂治疗晚期胃癌安全有效。     

FOLFOX4方案治疗晚期胃癌40例临床观察

目的观察FOLFOX4方案治疗晚期胃癌的临床疗效及毒副反应。方法40例晚期胃癌患者，给予FOLFOX4方案化疗。即：奥沙利铂（L-OHP）85mg／m^2。静脉点滴，2h，dl；亚叶酸钙（LV）200mg／m^2，静脉点滴，2h，d1，d2；氟尿嘧啶（5-FU）400mg／m^2静脉推注，后600mg／m^2微泵持续静脉滴注22h，d1，d2；每2周重复，4周为1周期。均治疗2周期以上，按WHO标准评价客观疗效和毒副反应。结果全组40例均可评价疗效，其中完全缓解（CR）3例，部分缓解（PR）17例，稳定（SD）13例，进展（PD）7例，总有效率（CR＋PR）50．0％。中位肿瘤进展时间（m）5．7个月，中位生存时间（MST）为9．8个月。毒副反应主要是骨髓抑制，胃肠道反应及外周神经毒性。白细胞下降发生率为75．0％。主要为Ⅰ／Ⅱ度反应，恶心呕吐发生率62．5％，腹泻30．0％。口腔粘膜炎22．5％。L—OHP引起的可逆性周围神经毒性发生率为45．0％，表现为肢端感觉异常，遇冷加重，但患者一般都能耐受。结论FOLFOX4方案治疗国人晚期胃癌的近期疗效较好，毒副反应可以耐受，值得进一步研究应用。     

完整结肠系膜切除术后DC-CIK联合奥沙利铂、卡培他滨治疗结肠癌对免疫水平的影响

目的 分析完整结肠系膜切除术后树突状细胞-细胞因子诱导杀伤细胞(DC-CIK cell)联合奥沙利铂、卡培他滨治疗结肠癌的临床效果.方法 回顾性分析2016年1月至2019年1月湖南省郴州市第一人民医院收治的128例结肠癌患者,按不同治疗方法分为两组,对照组54例,完整结肠系膜切除术后经奥沙利铂、卡培他滨治疗;观察组7...     

紫杉醇联合希罗达治疗晚期胃癌31例

目的:观察紫杉醇联合希罗达治疗31例晚期胃癌患者的疗效和副作用.方法:紫杉醇175 mg/m~2,静脉滴注3 h,第1天;希罗达1000 mg/m~2,po,2次/d,第1-14天,每21或28天为1个周期.每例患者治疗至少2个周期,2个周期化疗4 wk后评价疗效.结果:在可评价疗效的31例患者中,完全缓解(CR)1例(3.2%),部分缓解(PR)15例(48.4%),稳定(SD)10例(32.3%),进展(PD)5例(16.1%),总有效率(CR PR)51.6%,95%可信区间为33%-70%;临床获益者(CR PR SD)共26例(83.9%),95%可信区间为66%-94%;平均肿瘤进展时间(TTP)为5.32±1.85 mo;平均生存期(MST)为11.40±1.68 mo.不良反应主要为恶心呕吐、骨髓抑制、腹泻、手足综合征及脱发.结论:紫杉醇联合希罗达治疗晚期胃癌疗效好,副作用小,患者耐受性好.     

腹腔镜D2根治术联合完整系膜切除术治疗进展期胃癌的临床疗效分析

目的分析腹腔镜D2根治术联合完整系膜切除术(CME)治疗进展期胃癌的临床疗效。方法回顾性分析2018-01~2018-12于郑州大学第二附属医院行腹腔镜治疗的80例胃癌患者的临床资料,根据接受术式不同分为研究组(采用腹腔镜下D2根治术+CME治疗)和对照组(采用腹腔镜下标准D2根治术治疗),每组40例。比较两组手术时间、术中出血量、淋巴结清扫个数、术后功能恢复情况、术后并发症发生率以及术后1年生存情况。结果与对照组相比,研究组手术时间更短,术中出血量更少,淋巴结清扫个数更多,差异有统计学意义(P<0.05)。研究组首次排气时间、首次进食时间和住院时间显著短于对照组(P<0.05),腹腔引流管引流量显著少于对照组(P<0.05)。研究组术后并发症发生率显著低于对照组(22.50%vs 52.50%;χ²=10.912,P=0.000)。在随访过程中,研究组有8例(20.00%)出现肿瘤复发,对照组有16例(40.00%)出现肿瘤复发;研究组有2例(5.00%)死亡,对照组有5例(12.50%)死亡。log-rank检验结果显示,两组术后生存情况差异无统计学意义(χ²=2.735,P=0.143)。结论与标准D2根治术相比,D2根治术+CME术式手术时间更短,术中出血量更少,淋巴结清扫更彻底,术后肠道功能恢复更快,且术后并发症更少,值得临床推荐。     

紫杉醇与卡培他滨联合治疗进展期胃癌38例的临床疗效和安全性

目的评价紫杉醇与卡培他滨联合治疗进展期胃癌的临床疗效及安全性。方法随机抽取徐州医学院附属医院2012年11月-2014年4月收治的进展期胃癌患者76例作为研究对象,将其分为观察组和对照组,分别给予紫杉醇联合卡培他滨治疗和紫杉醇、顺铂和5-FU联合治疗,在治疗期间对其临床疗效和毒副反应进行评估分析。结果两组患者的有效率相比,差异无统计学意义(P0.05),而骨髓抑制和手足综合征的毒副反应相比,差异有统计学意义(P0.05)。结论紫杉醇联合卡培他滨联合治疗进展期胃癌安全有效,患者能够耐受毒副反应,值得临床推广使用。     

奥沙利铂联合希罗达或替加氟方案治疗老年晚期胃癌的临床观察

目的比较老年晚期胃癌应用奥沙利铂联合希罗达或替加氟方案化疗的疗效和安全性。方法 72例老年晚期胃癌按收治的时间顺序交替分为两组,A组用奥沙利铂联合希罗达方案化疗,B组用奥沙利铂联合替加氟加亚叶酸钙方案化疗,两组均化疗3个周期,比较两组的疗效和毒副反应。结果 A组化疗有效率36.1%,B组有效率38.9%,两组间疗效差异无统计学意义;两组初治均比复治有效率略高,但差异无统计学意义。毒副反应主要为血液学毒性、胃肠道反应和外周神经毒性、手足综合征。两组的白细胞减少及外周神经毒性无统计学差异。A组共发生血小板减少共12例,发生率33.3%,其中有2例Ⅲ度血小板减少;B组发生血小板减少共6例,发生率16.7%,未发生Ⅲ、Ⅳ度血小板减少。A组血小板减少发生率明显高于B组,两组有显著统计学差异(P<0.005)。B组胃肠道反应发生率为77.8%,且有2例Ⅲ度胃肠道反应,明显高于A组的61.1%,两者差异有统计学意义(P<0.05)。A组共发生手足综合征12例,其中2例为Ⅲ度,发生率为33.3%;B组共发生手足综合征5例,均为Ⅰ度,发生率为13.9%,两组手足综合征的发生率差异有统计学意义(P<0.05)。结论老年晚期胃癌应用奥沙利铂联合希罗达或替加氟方案化疗均取得较好的疗效,耐受性可。希罗达组的血液学毒性及手足综合征发生率较高,卡莫氟组胃肠道反应高于对照组。     

Endoscopic mucosal resection for treatment of early gastric cancer

BACKGROUND: In Japan, endoscopic mucosal resection (EMR) is accepted as a treatment option for cases of early gastric cancer (EGC) where the probability of lymph node metastasis is low. The results of EMR for EGC at the National Cancer Center Hospital, Tokyo, over a 11 year period are presented. METHODS: EMR was applied to patients with early cancers up to 30 mm in diameter that were of a well or moderately histologically differentiated type, and were superficially elevated and/or depressed (types I, IIa, and IIc) but without ulceration or definite signs of submucosal invasion. The resected specimens were carefully examined by serial sections at 2 mm intervals, and if histopathology revealed submucosal invasion and/or vessel involvement or if the resection margin was not clear, surgery was recommended. RESULTS: Four hundred and seventy nine cancers in 445 patients were treated by EMR from 1987 to 1998 but submucosal invasion was found on subsequent pathological examination in 74 tumours. Sixty nine percent of intramucosal cancers (278/405) were resected with a clear margin. Of 127 cancers without "complete resection", 14 underwent an additional operation and nine were treated endoscopically; the remainder had intensive follow up. Local recurrence in the stomach occurred in 17 lesions followed conservatively, in one lesion treated endoscopically, and in five lesions with complete resection. All tumours were diagnosed by follow up endoscopy and subsequently treated by surgery. There were no gastric cancer related deaths during a median follow up period of 38 months (3-120 months). Bleeding and perforation (5%) were two major complications of EMR but there were no treatment related deaths. CONCLUSION: In our experience, EMR allows us to perform less invasive treatment without sacrificing the possibility of cure.     

A study of metachronous cancer after endoscopic resection of early gastric cancer

Abstract

Objective. Endoscopic resection is commonly used for early gastric cancer (EGC) in Korea and Japan. There are only a few reports of metachronous cancer after endoscopic resection. The aim of this study was to identify clinical factors associated with metachronous gastric cancer after endoscopic resection. Methods. A total of 176 patients with EGC who had underwent endoscopic submucosal dissection (ESD) were periodically followed-up with endoscopic examinations from January 2004 to December 2007. The incidence and variable factors of metachronous gastric cancer were investigated in a retrospective study. Results. The median interval between the diagnosis of primary cancer and the diagnosis of the first metachronous cancer was 30 months (range 18–42 months). Metachronous gastric cancer had developed in nine patients (5.1%) during follow-up period and seven patients (4.0%) had synchronous gastric cancer lesions within 1 year of the initial endoscopic treatment. Annual incidence rate of metachronous cancer was approximately 3.3%. Antrum atrophy and old age were significantly associated with the incidence of metachronous cancer. The status of Helicobacter pylori, size, location and gross finding of lesion had no significant relationship with metachronous occurrence. Conclusions. We should examine more carefully older patients who have atrophic gastritis because secondary cancer including metachronous cancer might occur in remnant stomach after initial successful endoscopic resection. And prospective study will be needed for the optimal endoscopic surveillance interval.     

腹腔镜直肠癌根治术的研究进展

随着腹腔镜直肠癌根治手术的改进,其应用也越来越广泛,其手术的安全性、可行性、远期疗效及根治性也逐渐得到认可。该文对其研究进展作一综述。     

Risk factors and clinical outcomes of postgastrectomy sarcopenia newly developed after curative resection for gastric cancer

This study aimed to investigate the risk factors and clinical impact of newly developed sarcopenia after surgical resection on the prognosis of patients undergoing curative gastrectomy for gastric cancer (GC).The clinicopathological data of 573 consecutive patients with GC who underwent curative gastrectomy were reviewed. Their skeletal muscle mass and abdominal fat volume were measured using abdominal computed tomography.Forty six of them (8.0%) were diagnosed with preoperative sarcopenia. Among the 527 patients without sarcopenia, 57 (10.8%) were diagnosed with postgastrectomy sarcopenia newly developed 1 year after curative gastrectomy. Female sex, weight loss, proximal location of the tumor and differentiated tumor were significant risk factors of postgastectomy sarcopenia newly developed after curative gastrectomy. There was a significant difference in the 5-year overall survival among the preoperative sarcopenic, nonsarcopenic, and postgastrectomy sarcopenic groups (P = .017). Especially, there was a significant difference between nonsarcopenic and postgastrectomy sarcopenic groups (P = .009). However, there was no significant difference in the 5-year disease-free survival among the groups (P = .49).Since newly developed sarcopenia after surgical resection had an influence on the overall survival, patients with high sarcopenia risks after curative gastrectomy may require early nutritional support.