奥沙利铂联合氟尿嘧啶、亚叶酸钙方案（mFOLFOX7）对进展期胃癌的疗效分析

目的：观察奥沙利铂联合氟尿嘧啶、亚叶酸钙方案（mFOLFOX7）在进展期胃癌综合治疗中的作用。方法：48例进展期胃癌患者随机分为2组,常规治疗组24例采用外科手术加辅助化疗,综合治疗组24例采用mFOLFOX7的新辅助化疗-手术-术后辅助化疗,观察新辅助化疗对进展期胃癌的作用和毒性反应并比较2组无肿瘤残留（R0）切除率,手术并发症发生率和无病生存率。结果：综合治疗组完全缓解（CR）＋部分缓解（PR）14例（58.3%）完成了R0切除;常规治疗组中7例（29.2%）完成了R0切除。2组患者R0切除率差异有统计学意义（P〈0.05）;而术后并发症发生率、无病生存率比较差异无统计学意义（P均〉0.05）。结论：mFOLFOX7新辅助化疗方案毒性反应较低,能提高进展期胃癌R0切除率,不增加手术并发症,但未能提高进展期胃癌患者的无病生存率。     

局部进展期胃癌术前化疗的疗效分析

目的 探讨局部进展期胃癌术前化疗的疗效及安全性,以及影响术前化疗胃癌患者复发死亡的因素.方法 回顾性分析2007年7月至2011年6月间复旦大学附属中山医院肿瘤内科收治的49例局部进展期胃癌患者的临床资料.采用Cox比例风险模型来分析新辅助化疗患者复发死亡的危险因素.结果 其中48例患者化疗后在术前接受了影像学评估,术前化疗的有效率和疾病控制率分别为33.3％(16/48)和93.8％(45/48);另有1例因在化疗期间胃穿孔行急诊手术而未接受影像学评估.治疗后89.8％(44/49)的患者获得根治手术,其中90.9％的患者(40/44)接受了D2淋巴结清扫术.术后淋巴结转阴率为30.6％(15/49);术后病理有反应32例,其中2例获得完全病理缓解.术前化疗期间血液学毒性反应主要为白细胞下降,非血液学毒性反应主要为恶心呕吐,以1～2级为主.49例患者平均住院时间为11.6 d,其中2例(4.1％)分别因术后胰漏和胰周渗液而延长了住院时间.49例患者均接受了术后随访,中位随访时间为21.6个月,中位无复发生存期为29.6个月(95％CI:24.0～35.2),中位总生存期为34.6个月(95％CI:29.8～39.4).多因素预后分析显示,影像学疗效(P.=0.038,RR=0.168,95％CI:0.031～0.904)和病理反应(P=0.007,RR=0.203,95％CI:0.064～0.642)是影响本组患者术后复发死亡的独立因素.结论 术前化疗对于局部进展期胃癌具有较高的疾病控制率和R0切除率;影像学疗效和病理反应是影响局部进展期胃癌术前化疗患者最重要的预后指标.     

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??Complications after radical gastrectomy following neoadjuvant chemotherapy for gastric cancer LI Zi-yu, JI Xin, JI Jia-fu. Department of Gastrointestinal Surgery, Beijing Cancer Hospital and Institute, Peking University School of Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing100142, China
Corresponding author: LI Zi-yu, E-mail: ligregory369@hotmail.com
Abstract The concept of neoadjuvant chemotherapy has been widely accepted recently for the benefit of increasing the R0 resection rate and the long-term survival in patients with gastric cancer. To date, owing to the results of the Medical Research Council Adjuvant Gastric Infusional Chemotherapy (MAGIC) trial, perioperative chemotherapy for locally advanced resectable gastric cancer has become a grade A recommendation. There are limited data available regarding postoperative morbidity and mortality in patients performed neoadjuvant chemotherapy for gastric cancer. If neoadjuvant chemotherapy is going to be considered as a therapeutic option in patients with locally advanced gastric cancer, it is necessary to verify that it can be delivered safely without an increase in postoperative morbidity and mortality.     

进展期胃癌新辅助化疗的研究进展

目的总结进展期胃癌新辅助化疗的研究进展。方法采用文献复习的方法,对有关进展期胃癌新辅助化疗研究进展的文献进行综述。结果进展期胃癌的新辅助化疗可显著提高R0切除率,提高远期生存率,降低死亡风险。对于无远处转移的局部进展期胃癌的新辅助化疗时间一般为6~9周,然后根据疗效评价结果决定是否进行手术治疗;进一步深入的临床研究及化疗敏感程度检测方法的改进有助于新辅助化疗标准的统一。结论进展期胃癌新辅助化疗的疗效已比较明确,但其在适应证、化疗方案、用药时限、疗效评价指标等方面尚无明确的统一标准,仍需要多中心、大型的临床试验进行深入的研究。     

Esophageal adenocarcinomas in heterotopic gastric mucosa: review and report of a case with complete response to neoadjuvant radiochemotherapy

Adenocarcinomas are exceedingly rare in the cervical esophagus (26 reported cases), where squamous cell cancer (SCC) is the predominant tumor type. Esophageal heterotopic gastric mucosa (HGM) - a frequent remnant of incomplete replacement of the original columnar epithelium during the embryonic period - is suspected as cellular origin of cervical esophageal adenocarcinomas. As in any rare tumor entity, no standard treatment strategy is available for cervical esophageal adenocarcinomas. We herein report about the case of a 52-year-old man with a locally advanced, irresectable cervical esophageal adenocarcinoma originating in HGM. We decided on a neoadjuvant therapy (48.6 Gy + 5-FU/cisplatin) derived from experiences with SCC. Restaging showed an extraordinary good clinical response of the previously irresectable tumor. Subsequently the patient underwent limited cervical esophageal resection, lymphadenectomy and interposition of a free jejunal loop for reconstruction. Postoperative histopathological work-up of the specimen showed no residual tumor tissue, but unchanged HGM. This is the first case with complete response of a rare cervical esophageal adenocarcinoma to a neoadjuvant protocol. On 3-year follow-up the patient is doing fine with no complaints of dysphagia and no evidence of local or systemic recurrence.     

SOX方案新辅助化疗应用于进展期胃癌的有效性和安全性研究

目的探讨进展期胃癌应用替吉奥胶囊联合注射用奥沙利铂（SOX方案）新辅助化疗的有效性和安全性。方法回顾性分析解放军总医院普通外科2009年11月至2010年9月收治66例符合入组条件的进展期胃癌患者临床病例资料。32例患者予以术前SOX方案化疗（新辅助化疗组）。SOX方案具体为：替吉奥胶囊80mg·（m2）-1·d-1,第1～14天．注射用奥沙利铂130mg／m2,第1天;3周重复。每2个治疗周期后进行化疗有效性和安全性评估。其余34例患者直接行外科手术（对照组）。统计所有手术患者R0切除率和D2淋巴结清扫率。结果新辅助化疗组化疗有效率为68．8％,疾病控制率为93．8％;3-4级不良反应主要为呕吐（12．5％）、肝功能异常（9．4％）、贫血（6．3％）、中性粒细胞减少（6.3％）和食欲减退（6.3％）;化疗后进行外科手术,其中25例（78．1％）行胃癌D2根治术,凡切除率为81．3％。对照组中,行D2根治术23例（67．6％）,与新辅助化疗组比较,差异有统计学意义（P=0．028）;R0切除率为73．5％,与新辅助化疗组比较,差异亦有统计学意义（P=0．040）。结论进展期胃癌应用SOX新辅助化疗具有较高的有效性,而不良反应率较低,能够提高D2根治率和R0切除率。     

Does Graded Histologic Response After Neoadjuvant Chemotherapy Predict Survival for Completely Resected Gastric Cancer?

Background After publication of the MAGIC trial results, preoperative chemotherapy is increasingly used to treat advanced gastric cancer before resection. Tools for measuring response must be assessed. Methods We identified all patients with gastric cancer treated with neoadjuvant chemotherapy and R0 resection between 1991 and 2005 from a prospective database. Patients receiving preoperative radiation were excluded. Histologic response to treatment was graded from 0% to 100% by a single pathologist. Kaplan-Meier survival analysis was performed to identify the relationship between response and outcome and to identify factors predictive of disease-specific survival (DSS). Multivariate analysis was performed to identify independent predictors. Results A total of 168 patients underwent R0 resection after receiving neoadjuvant chemotherapy. Thirty-three percent of tumors were at the gastroesophageal junction. Cisplatin-based therapy was used for 68% of patients. Twenty-two percent of patients had a >50% pathologic response to treatment. Median follow-up after resection for all patients was 25 months. Median DSS for all patients was 33 months. Three-year DSS improved from 44% to 69% with at least a 50% histologic response (P = .01). Factors associated with decreased DSS included positive nodes at resection, pT3 tumor or greater, high grade, perineural or vascular invasion, and <50% response. Multivariate analysis identified nodal status and perineural or vascular invasion as independent predictors of survival. Conclusions Posttreatment nodal status and perineural or vascular invasion at resection, but not graded histologic response, independently predict DSS after neoadjuvant chemotherapy and surgical resection of gastric cancer.     

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??Content analysis of domestic and international guidelines about comprehensive treatment of advanced gastric cancer LI Guo-li??XIANG Xiao-song. Research Institute of General Surgery, General Hospital of Nanjing Military Command of the Chinese People’s Liberation Army, Nanjing 210002??China
Corresponding author??LI Guo-li??E-mail??drguoli@163.com
Abstract In China, advanced gastric cancer with severe local progression or distant metastasis is more common. How to improve the survival of patients with advanced gastric cancer by multimodality therapies??such as splenectomy??bursectomy and neoadjuvant chemotherapy, and the treatment of advanced gastric cancer accompanied by metastasis to the para-aortic lymph nodes or peritoneal metastasis has been focused on by Chinese scholars. Based on the recently released results of JCOG0110 and 1001 research, the fifth edition of Japanese gastric cancer treatment guidelines currently does not recommend conventional combined splenectomy and bursectomy. Compared with the current situation that the advanced gastric cancer is dominant in China, however, these patients of the two projects showed a low degree of progression and malignancy. Therefore, the clinical significance of these two surgeries should not be completely denied in China. There is no unified treatment plan for the local advanced gastric cancer that has no distant metastasis but is difficult to resect. In fact, a large number of studies have demonstrated that neoadjuvant chemotherapy can improve the resection rate of R0 and prolong the survival time. The author finds out that the preoperative chemotherapy with arterial + vein administration can increase the chemotherapy response rate and improve the survival of patients. There are also many domestic and foreign studies have shown that chemotherapy, radiation therapy, intraperitoneal chemotherapy and other multimodality therapies can effectively prolong the survival time of the patients even with advanced gastric cancer accompanied by metastasis to the para-aortic lymph nodes or peritoneal metastasis. The author believes that it is advisable to actively treat patients with advanced gastric cancer in China through the individualized multidisciplinary comprehensive treatment model so as to improve their survival.     

Utilization of multimodal therapy concepts in stomach carcinoma in Germany

INTRODUCTION: In view of disappointing results after surgery alone multimodal therapeutic regimes are used to improve long-term prognosis in locally advanced gastric carcinomas. In presence of many reports about encouraging results ("down staging", improved R0-resection rates) but simultaneously missing evidence of efficiency of neoadjuvant therapies in respect to long-term survival (large randomized multicenter trials do not exist until today) and the herewith related uncertainties, we started an inquiry among many surgical units with the intention to evaluate the clinical practice of multimodal treatment for gastric cancer patients in Germany today. METHODS: In a questionnaire (3/99) we asked among 97 surgical units (41 university hospitals, 56 big community hospitals) in Germany for the management of gastric cancer patients with special interest to practice and state of adjuvant and neoadjuvant therapeutic strategies. Further we analyzed all resected gastric cancer patients (1986-1995) without neoadjuvant treatment in advanced stage of disease (pT3/4NxMx; stage III/IV (UICC'92) in respect to R0-resection rate and long-term prognosis (Kaplan-Meier). RESULTS: Overall feedback amounted to 78% (76/97) and was higher in university hospitals (90%) than in big community hospitals (70%). Today, neoadjuvant therapies are of more interest than adjuvant therapeutic regimes. But also neoadjuvant therapy is only used in 32% as a rule (in 16% with, in 16% without study conditions). 25% of all surgical units do not employ any neoadjuvant therapy in locally advanced gastric cancer until today. In all other surgical units neoadjuvant treatment is performed more individually and sporadically (43%) only in some patients. Neoadjuvant therapies are practiced by haematooncologists in 50%, gastroenterologists in 32% and surgeons in 27%. The predominant neoadjuvant therapeutic strategy is chemotherapy alone (84%). Many surgical units in Germany are interested to participate in a multicenter trial with more interest in neoadjuvant than adjuvant therapy. 185 of 309 resected gastric cancer patients (60%) were classified as stage IIIa, stage IIIb or stage IV patients. R0-resection rate of these advanced gastric cancer patients amounted to 37%; only 24% of them survived 5 years or more. CONCLUSIONS: Considering the missing evidence that multimodal therapies are able to prolong long-term survival in advanced gastric cancer patients, its use without study conditions is questionable. Conclusions, taken from data of clinical trials regarding carcinomas of the esophagus and esophagealgastric junction, are inconsistent in respect to long-term prognosis and results are not transferable to gastric carcinomas. A prospective randomized multicenter trial in advanced gastric cancer patients is of great importance. Following our data, in Germany a high readiness to participate in the forthcoming EORTC-study is present.     

围手术期化疗加外科手术治疗晚期胃癌

目的 探讨围手术期化疗加外科手术治疗晚期胃癌的效果.方法 2006年3月到2009年9月共24例晚期胃癌患者入组,其中ⅣM0期14例,Ⅳ M1期10例;其中包括肝转移5例,腹膜种植转移4例,肺转移1例.予紫杉醇+顺铂+5-氟尿嘧啶(PCF)或表阿霉素+顺铂+5-氟尿嘧啶(ECF)方案化疗2～4疗程,然后手术治疗,手术后继续术前方案化疗2～4疗程.结果 本组中7例未进行手术治疗,其中4例因疾病进展放弃手术,另外3例因其他原因自动放弃手术治疗;17例进行手术治疗,其中16例达到R0切除,R0切除率为94%;完成术前化疗的病例中总临床反应率为75%,病理总反应率为82%;59%(10例)患者血清CEA和CA199水平恢复至正常;71%(12/17)病例术后病理分期明显下降;患者Ⅲ～Ⅳ级粒细胞减少、血小板减少、贫血的发生率分别为79%、8%、13%,2例Ⅲ～Ⅳ级粒细胞减少伴发热,Ⅲ～Ⅳ级恶心、呕吐发生率为54%;无治疗相关的死亡病例.结论 对部分晚期胃癌可考虑行术前化疗及有计划的外科手术治疗.     

Neoadjuvant chemotherapy in gastric carcinoma

A complete surgical resection currently represents the only curative treatment option for gastric carcinoma, but as regards locally advanced cancer the possibility of local or distant recurrence remains extremely high even following a R0 resection. As far as T3-4/N+ tumors are concerned, unsatisfying results of surgery alone have stressed the need for multimodal treatments: in the recent past adjuvant chemotherapy has represented a common complementary treatment for locally advanced gastric cancer, but conclusive results of most randomized trials did not show a significant impact on long term survival. Literature review shows a growing trend throughout the 90's towards the adoption of a preoperative chemotherapy, initially evaluated as a form of "salvage" palliative treatment for unresectable patients. To date a number of phase II study suggests the efficacy of neo-adjuvant treatment administered to resectable patients with the purpose of inducing tumor downstaging, increasing the rate of R0 resections and controlling recurrencies. From March 1996 the Authors have started a controlled study on neo-adjuvant therapy for locally advanced gastric cancer. Accurate staging and patients selection were based upon immediately preoperative laparoscopy. In this ongoing study, patients are administered two preoperative cycles of EEP chemotherapy (Etoposide, Epirubicin, cis-Platin). Preliminary data have been evaluated on the first 15 cases. Grade I myelosuppression has been observed in 12/15 cases and grade II/III in 3/15 cases; 1 patient died by septic complications. Restaging has not shown progression of the disease in 13/14 cases; a macroscopic response was evidenced in 7/14 patients; 14/14 patients could undergo a successful D2 surgical resection following neo-adjuvant therapy. Pathological staging confirmed tumor downstaging in 7 out of 14 cases; 12/14 patients in this group (85.7%) could benefit a R0 resection. These preliminary data encourage us to proceed in our prospective investigation.     

Ist neoadjuvante Therapie für lokal fortgeschrittene Magenkarzinome Standard?

Despite surgical efforts and encouraging data of a few postoperative therapy trials, locally advanced gastric cancer is in need of the development of effective multimodal therapeutic concepts. Regarding preoperative therapy the goal is to raise the number of complete tumor resections (R0-resections) leading to an improved prognosis of the disease. Neoadjuvant therapy has the theoretical advantage of early destruction of distant micrometastasis with a consecutive reduction of tumor relapse outside the resection margins. The likelyhood of R0-resections should be increased with the response of the primary tumor to neoadjuvant therapy. Neoadjuvant chemotherapy using platinum based regimens in gastric cancer has shown its activity in a number of phase II studies. Especially after response to chemotherapy the survival was significantly better after complete surgical tumor resection. The neoadjuvant use of a sequence of chemotherapy followed by radiotherapy before gastrectomy did result in a complete histopathological response in 20–25% of gastric cancer patients. This regimen seems to be promising, but there are still no long term results available. Parallel to the expected data from the first phase III studies the main impact of research in this field has to be focused on to the development of new and effective therapeutic agents and with accompanying identification of factors which are able to predict the response to neoadjuvant treatment.     

Complications of gastrectomy following CPT-11-based neoadjuvant chemotherapy for gastric cancer

Potential benefits of neoadjuvant therapy for locally advanced gastric cancer include tumor downstaging and an increased R0 resection rate. Potential disadvantages include increased surgical complications. This study assesses postoperative morbidity and mortality by comparing patients undergoing gastrectomy with and without neoadjuvant chemotherapy. From October 1998 to July 2002, a total of 34 patients with locally advanced gastric cancer were placed on a phase II neoadjuvant chemotherapy protocol consisting of two cycles of CPT-11 (75 mg/m²) with cisplatin (25 mg/m²). Demographic, clinical, morbidity, and mortality data were compared for these patients (CHEMO) versus 85 patients undergoing gastrectomy without neoadjuvant chemotherapy (SURG). The CHEMO patients were more likely to be less than 70 years of age (P ≦ 0.01), have proximal tumors (P ≦ 0.01), and undergo proximal gastrectomy (P ≦ 0.025). Fifty-two percent of SURG patients had T3/T4 tumors compared to 19% of CHEMO patients, consistent with tumor downstaging. The R0 resection rate was similar (80%). Morbidity was 41% in CHEMO patients and 39% in SURG patients. There were five postoperative deaths (4.4%), two in the CHEMO group and three in the SURG group (P = NS). It was concluded that neoadjuvant chemotherapy with CPT-11 and cisplatin is not associated with increased postoperative morbidity compared to surgery alone. CPT-11-based neoadjuvant chemotherapy should be tested further in combined-modality treatment of gastric cancer. Presented at the Forty-Fourth Annual Meeting of The Society for Surgery of the Alimentary Tract, Orlando, Florida, May 17–22, 2003 (oral presentation). Supported in part by Pharmacia Oncology and grants NCI/NIH CA16087 and GCRC M01RR00096.     

Systemic neoadjuvant chemotherapy in locally advanced gastric carcinoma: phase II study with 5-fluorouracil, epirubicin and etoposide

Locally advanced gastric adenocarcinomas have a poor prognosis, particularly when the tumours are bulky, located in the cardia or when they present local/regional lymph node involvement. Neoadjuvant chemotherapy for locally advanced gastric cancer is an experimental treatment strategy that may increase resectability and improve survival in patients suffering from an almost uniformly fatal neoplasm. At our institution 11 patients younger than 70 years of age in good physical and mental condition with non-resectable adenocarcinomas of the stomach as determined by endoscopy, computed tomography scans and pathology examinations, were treated with combination chemotherapy [5-fluorouracil (375 mg/m2 i.v. for 5 days, epirubicin (60 mg/m2 i.v. on day 1), etoposide 80 mg/m2 on days 1, 2 and 3, leucovorin 100 mg/m2 for 5 days] every 4 weeks as neoadjuvant chemotherapy. The response to chemotherapy was evaluated after three courses. After three courses, we had one complete response, 8 partial responses or stable disease, and no response in two cases. One patient was still alive 36 months postoperatively. These preliminary results suggest that this protocol is an effective form of neoadjuvant chemotherapy for locally advanced gastric carcinoma.     

SOX新辅助化疗在进展期胃癌的治疗体会

目的 观察奥沙利铂联合替吉奥（SOX方案）新辅助化疗对进展期胃癌手术切除率及临床疗效的影响。方法 选取青海省人民医院和南方医科大学附属花都医院2016年5月~2019年7月收治的40例无远处转移的进展期胃癌患者,根据治疗方法的不同分为化疗组（n=20）与非化疗组（n=20）,两组都给予常规手术治疗,化疗组在此基础上给予SOX方案化疗。观察如下指标：化疗组比较化疗前后胃壁、局部淋巴结、门静脉癌栓影像学表现;术中比较两组之间幽门不全梗阻、胃壁组织水肿情况及肿瘤与周围组织的粘连情况;术后比较两组手术切除率、术中出血量、淋巴结转移、平均住院日、R0切除情况及术后肿瘤TNM分期情况。结果 化疗组化疗后胃壁变薄,肿瘤缩小,周围肿大淋巴结减少缩小,门静脉癌栓明显好转;与对照组相比,化疗组术中的幽门不全梗阻、胃壁组织水肿情况、肿瘤与周围组织的粘连情况较非化疗组获得了明显的改善（P<0.05）;化疗组的术后切除率高、淋巴结转移少、手术平均住院日短,且提高了R0切除率并降低了术后TNM分期,两组之间差别均具有统计学意义（P<0.05）。结论 对于术前评估分期在ⅢA~Ⅵ期无远处转移的进展期胃癌患者,SOX新辅助化疗方案可显著提高根治性手术切除率,且患者耐受性良好。     

Appraisal of Treatment Strategy by Staging Laparoscopy for Locally Advanced Gastric Cancer

More accurate preoperative staging is necessary to determine the treatment strategy for locally advanced gastric cancer. Thirty-two patients with T3 or T4 gastric cancer expected to undergo curative resection based on conventional examinations underwent staging laparoscopy. The disease stages determined were compared with those obtained by conventional methods. The discrepancy rate of disease staging was 16 of 32 (50.0%), with down-staging in 5 of 32 (15.6%) and up-staging in 11 of 32 (34.4%). Of the 32 patients, 13 (40.6%) were found to have unsuspected peritoneal dissemination. The positive predictive value for peritoneal metastasis by staging laparoscopy was 100%, whereas the negative predictive value was 89% (17/19). The accuracy rate was 94%. After laparoscopy, 15 of the 32 (46.9%) were diagnosed as candidates for curative resection. Of these 15 patients who underwent surgery, 13 (86.7%) underwent curative resection (1 R0 and 12 R1); the remaining two underwent R2 resection because of peritoneal metastasis that was undetected by staging laparoscopy. Patients with tumors judged noncurable by laparoscopy (n= 11) received neoadjuvant chemotherapy. In 7 of the 11 cases, salvage surgery was done (one R0, three R1, three R2 resections). A second staging laparoscopy was performed in four cases to determine the indication for salvage surgery. Three of the four were judged to be curable and underwent curative resection. Staging laparoscopy is an effective tool for detecting unsuspected peritoneal metastasis, and it can increase the curative resection rate and decrease unnecessary laparotomy for advanced gastric cancer. Second-look laparoscopy enables accurate assessment of the chemotherapeutic response, which can help in decisions about salvage surgery.     

紫杉醇联合FOLFOX4方案新辅助化疗在进展期胃癌中的临床应用

目的 评价紫杉醇联合FOLFOX4方案（氟尿嘧啶、甲酰四氢叶酸和奥沙利铂）新辅助化疗治疗进展期胃癌的临床疗效及不良反应.方法 应用前瞻性随机对照的方法将cTNM分期为Ⅲ或Ⅳ期（M0） 的胃癌患者78例,按入组顺序根据随机数字表法随机分配到试验组（39例）和对照组（39例）.试验组给予紫杉醇联合FOLFOX4方案的新辅助化疗,每2周为1周期,3周期后采用RECIST标准评价临床疗效,2～4周后手术,术后给予原方案化疗3周期.若术前评效为疾病进展（PD）者,术后改为ECF方案（表阿霉素、顺铂和氟尿嘧啶）化疗.对照组确诊后2周内手术.术后给予6周期紫杉醇联合FOLFOX4方案的辅助化疗.结果 试验组紫杉醇联合FOLFOX4方案新辅助化疗的临床有效率为66.7%,R0切除率（82.1%）明显高于对照组（59.0%）（P＝0.025）,淋巴结转移数目[（3.23±2.80）枚]明显少于对照组[（5.79±2.69）枚]（P＝0.001）,术后并发症发生率（5.1%和2.6%）及淋巴结清扫数目[（19.69±2.95）枚和（20.59±3.22）枚]两组差异均无统计学意义（P＞0.05）.试验组和对照组术后中位生存期分别为（27.10±2.32）个月和（18.20±1.30）个月（P＝0.006）.Cox回归多因素分析显示,肿瘤分化程度、R0切除、淋巴结转移均是影响预后的独立因素.化疗不良反应主要为血液学及末梢神经毒性,患者均可耐受,两组化疗不良反应差异无统计学意义（P＞0.05）.结论 紫杉醇联合FOLFOX4方案新辅助化疗有效率高,患者耐受性和依从性好,可提高进展期胃癌患者的R0切除率、降低淋巴结转移率,提高生存率.     

紫杉醇联合FOLFOX4方案新辅助化疗在进展期胃癌中的临床应用

目的 评价紫杉醇联合FOLFOX4方案(氟尿嘧啶、甲酰四氢叶酸和奥沙利铂)新辅助化疗治疗进展期胃癌的临床疗效及不良反应.方法 应用前瞻性随机对照的方法将cTNM分期为Ⅲ或Ⅳ期(M0) 的胃癌患者78例,按入组顺序根据随机数字表法随机分配到试验组(39例)和对照组(39例).试验组给予紫杉醇联合FOLFOX4方案的新辅助化疗,每2周为1周期,3周期后采用RECIST标准评价临床疗效,2～4周后手术,术后给予原方案化疗3周期.若术前评效为疾病进展(PD)者,术后改为ECF方案(表阿霉素、顺铂和氟尿嘧啶)化疗.对照组确诊后2周内手术.术后给予6周期紫杉醇联合FOLFOX4方案的辅助化疗.结果 试验组紫杉醇联合FOLFOX4方案新辅助化疗的临床有效率为66.7%,R0切除率(82.1%)明显高于对照组(59.0%)(P＝0.025),淋巴结转移数目[(3.23±2.80)枚]明显少于对照组[(5.79±2.69)枚](P＝0.001),术后并发症发生率(5.1%和2.6%)及淋巴结清扫数目[(19.69±2.95)枚和(20.59±3.22)枚]两组差异均无统计学意义(P＞0.05).试验组和对照组术后中位生存期分别为(27.10±2.32)个月和(18.20±1.30)个月(P＝0.006).Cox回归多因素分析显示,肿瘤分化程度、R0切除、淋巴结转移均是影响预后的独立因素.化疗不良反应主要为血液学及末梢神经毒性,患者均可耐受,两组化疗不良反应差异无统计学意义(P＞0.05).结论 紫杉醇联合FOLFOX4方案新辅助化疗有效率高,患者耐受性和依从性好,可提高进展期胃癌患者的R0切除率、降低淋巴结转移率,提高生存率.     

DOX新辅助化疗方案对进展期食管胃交界部癌和远端胃癌的效果评价

目的探讨DOX方案新辅助化疗在进展期食管胃交界部癌（adenocarcinomaofesopha—gogastricjunction,AEG）及远端胃癌（distalgastriccancer,DGC）治疗中的作用。方法收集2008年10月至2011年3月间确诊的进展期胃癌患者58例,其中食管胃交界部腺癌18例（AEG组）,远端胃癌40例（DGC组）,术前行DOX方案化疗2周期,于化疗后14—21d行手术治疗。结果两组患者均完成术前新辅助化疗,化疗后AEG组CR3例,PR12例,SD3例,PD0例,总有效率为83．3％;DGC组CR2例,PR20例,SD17例,PD1例,总有效率55．0％,两组差异有统计学意义（P〈0．05）。AEG及GC的R0切除率分别为88．8％及87．5％,差异无统计学意义（P〉0．05）。两组化疗主要不良反应为粒细胞减少、胃肠道不良反应及外周神经毒性;术后并发症发生率差异无统计学意义（均P〉0．05）。两组1年生存率均为100％;AEG组2年生存率（77．8％）比DGC组（75．0％）亦无统计学差异（均P〉0．05）。结论DOX方案新辅助化疗对食管胃交界部癌较远端胃癌效果更好,缩小肿瘤、降低分期更明显,但远期疗效尚待进一步随访。     

肿瘤血管正常化窗口对不能切除胃癌患者新辅助治疗的指导

目的探讨按“肿瘤血管正常化窗口（NWTV）”假设对不能切除的胃癌患者进行新辅助治疗的合理性。方法前瞻性收集2010年10月至2011年3月间武汉大学人民医院收治的进展期及局部晚期不能切除的93例胃癌患者,按随机数字表法分为A组[30例,采用FOLFOX4（奥沙利铂、四氢叶酸和氟尿嘧啶）常规新辅助化疗]、B组（29例,前述方案加贝伐单抗靶向治疗）和C组（34例,按NWTV假设,按B组方案进行新辅助化疗,贝伐单抗用药5d后按A组方案治疗）。比较3组新辅助治疗的疗效、不良反应及临床结局。结果3组患者一般资料的差异无统计学意义（P〉0．05）。所有患者均按计划完成了新辅助化疗．新辅助化疗疗效和不良反应3组问的差异均无统计学意义（均P〉0．05）。3组新辅助化疗后肿瘤分期下降率分别为56．7％（17／30）、72．4％（21／29）和85．3％（29／34）,C组明显高于A组（P〈0．05）;R0切除率分别为23．3％（7／30）、27．6％（8／29）和52．9％（18／34）．C组明显高于A组和B组（均P〈O．05）。3组患者均未出现围手术期死亡病例．术后并发症发生率的差异亦无统计学意义（P〉0．05）。结论抗血管生成剂应用于胃癌的新辅助治疗中能改善临床疗效,按NSTV窗口指导的给药方式效果更佳。