可切除胃癌术后辅助化疗现状

世界范围内,胃癌发病率和死亡率占所有癌症的第2位.在中国胃癌占发病和死亡的第1位.5年生存率低.手术是惟一可根治的方法.术后辅助化疗在提高生存率方面的作用尚有争议.本文综述胃癌根治术后辅助化疗方面的现状.     

胃癌的辅助化疗

胃癌病变局限在粘膜层或粘膜下层者术后 5年生存率为 95 %～ 98% ;病变侵及肌层者 ,术后 5年生存率为 40 %～ 5 0 % ,而病变侵及浆膜或以外者 ,术后 5年生存则仅 0 %～ 1 0 % ,所以胃癌的辅助化疗占有重要的位置。1　术后辅助化疗胃癌切除术后 ,根据病变侵犯深度及有否淋巴结转移 ,或术中所见肿瘤情况 ,决定术后是否进行辅助化疗。病变局限于粘膜或粘膜下层 ,淋巴结无转移者 ,术后定期观察 ,不作化疗 ;病变侵及肌层或肌层以外 ,术后常规辅助化疗 ;无论病变侵犯深度如何 ,凡淋巴结有转移的 ,术后应常规行辅助化疗 ;尽管已行根治术 ,但有潜在…     

胃癌术后辅助化疗的研究进展#br#

胃癌术后辅助化疗是改善患者预后的重要方法。术后辅助化疗的作用已被明确,但目前在首选术后辅助方案上仍未达成统一的全球共识。尽管治疗方案因地区而异,但各种推荐辅助化疗方案在改善生存率上均存在有力的证据。为此,多年来人们一直在探索其合适治疗人群和最佳化疗方案,各国开展的多项研究基本证实了术后辅助化疗的作用并对比不同术后化疗方案的生存获益情况,本文将对胃癌术后辅助治疗的现状及研究进展作一综述。     

102例术后乳腺癌辅助化疗后贫血相关因素分析

[目的]探讨乳腺癌术后辅助化疗后贫血发生的相关因素.[方法]回顾性分析102例乳腺癌辅助化疗病人化疗前及每周期化疗后血红蛋白值,按分期分组观察每周期化疗后贫血发生率;按手术方式分组观察每周期化疗后贫血发生率;按化疗前血红蛋白水平分组观察每周期化疗后贫血发生率.[结果]Ⅰ、Ⅱ、Ⅲ期病人,化疗后贫血发生率无显著性差异(P＜0.05),乳房切除术的病人,贫血发生率高于乳房保留术的病人(3周期后P＜0.05,4周期后P＜0.01),化疗前血红蛋白水平低于110g/L的病人,与化疗前血红蛋白水平高于等于110g/L的病人相比,化疗后贫血发生率升高;化疗前血红蛋白水平＜120g/L的病人,与化疗前血红蛋白水平高于等于120g/L的病人相比,化疗后贫血发生率升高.[结论]乳腺癌术后接受辅助化疗的病人,贫血发生率与临床分期无关,与手术方式有关.     

胃癌辅助化疗的研究进展

胃癌一直是肿瘤死亡的主要原因,手术根治性切除是治愈的唯一手段。胃癌辅助化疗是在根治性手术后减少局部和远处复发的方法。许多Ⅲ期临床研究试图证实辅助治疗的疗效,但至今仍没有确立标准的治疗方案。本文就辅助治疗在胃癌中的进展作一总结。     

胃癌辅助化疗的研究进展

胃癌一直是肿瘤死亡的主要原因,手术根治性切除是治愈的唯一手段。胃癌辅助化疗是在根治性手术后减少局部和远处复发的方法。许多Ⅲ期临床研究试图证实辅助治疗的疗效,但至今仍没有确立标准的治疗方案。本文就辅助治疗在胃癌中的进展作一总结。     

影响进展期胃癌新辅助化疗患者临床疗效的危险因素

目的 探讨影响进展期胃癌新辅助化疗患者临床疗效的危险因素并进行多元Logistic回归分析.方法 116例进展期胃癌患者的临床资料进行回顾性分析,找出可能影响其临床疗效的相关因素,并行多元Logistic回归分析.结果 进展期胃癌患者治疗总有效率与患者年龄、肿瘤部位、体质指数、淋巴结廓清范围无相关性(P＞0.05);与肿瘤直径、Borrmann分型、TNM分期、组织学类型、切缘情况有显著相关性(P＜0.05);多因素分析显示,肿瘤直径(OR=5.367)、TNM分期(OR =5.101)、切缘情况(OR=4.802)、Borrmann分型(OR =4.237)、组织学类型(OR=3.039)均为影响进展期胃癌患者临床疗效的危险因素.结论 肿瘤直径、TNM分期、切缘情况、Borrmann分型、组织学类型均为影响进展期胃癌临床疗效的危险因素,应根据患者各项检查结果选择最佳治疗方案,提高其临床疗效.     

基于辅助化疗前血清白蛋白水平的列线图预测胃癌患者术后复发及远期生存

[目的]对于胃癌根治术后接受辅助化疗的患者,构建基于化疗开始前血清白蛋白水平的预后预测模型。[方法]回顾性分析根治术后接受辅助化疗的胃癌患者的临床、病理资料以及生存数据;依据时间依赖性受试者工作特征曲线(ROC曲线)确定白蛋白水平的最佳截断值;采用多因素Cox回归分析校正混杂因素,探讨白蛋白水平对无病生存期(disease-free survival,DFS)和总生存期(overall survival,OS)的影响;绘制预测列线图并进行验证。[结果]共纳入121例患者,白蛋白对12个月OS影响的曲线下面积(area under curve, AUC)为0.69(95%CI:0.55~0.83),白蛋白最佳截断值为37.0 g/L。Cox回归分析结果提示化疗前血清白蛋白<37.0 g/L、低/差分化肿瘤和存在癌结节是增加患者复发及死亡风险的独立因素。基于3个参数构建的列线图预测DFS和OS的c-指数分别为0.671(95%CI:0.526~0.816)和0.649(95%CI:0.553~0.745),校准曲线基本沿45°线分布。[结论]对于接受辅助化疗的胃癌根治术后患者,基于化疗开始前血清白蛋白水平的列线图可用于预测复发、转移和生存结局。     

胃癌辅助化疗新进展与挑战

<正>虽然流行病学调查研究提示近年来胃癌的发病率有所下降,胃癌仍是世界范围内死亡率较高的常见肿瘤,5年生存率低于20%。胃是腹腔内消化道的第一关,起自胃食管结合部,止于幽门。从食管远端5cm到胃近端5cm这个胃食管结合部仍存在争议。国际抗癌联盟(UICC)和美国癌症联合会(AJCC)新修订的第七版癌症     

香菇多糖辅助胃癌患者术后化疗的临床观察

目的 :探讨香菇多糖减轻胃癌患者术后化疗毒副反应的效果和对患者长期生存的影响。方法 :设计两组患者作为研究对象 ,对照组 (n =5 1)用 5 Fu、阿霉素、丝裂霉素方案 ;治疗组 (n =32 )用香菇多糖、5 Fu、阿霉素、丝裂霉素方案。毒副反应按WHO标准评估 ,长期生存及长期无瘤生存用寿命表法分析。结果 :治疗组比对照组在血液学 (P <0 0 1)、胃肠道 (P <0 0 1)、皮肤及毛发 (0 0 5 >P >0 0 1)上的毒副反应明显下降 ;且较对照组能耐受更多疗程化疗 (P <0 0 1) ;但在五年生存率及五年无瘤生存率上治疗组与对照组无显著性差异 (五年生存率分别是 4 6 88%和 4 5 10 % ,P >0 0 5 ,五年无瘤生存率相同 )。结论 :香菇多糖可减少胃癌患者术后化疗的毒副反应 ,但对长期生存无明显影响     

Dose intensity of mitomycin C in adjuvant cancer chemotherapy for patients with gastric cancer

Using a cohort of macroscopic curative resections of gastric cancer at stages II, III, and IV, a randomized controlled trial was performed to elucidate the dose efficacy of intensive adjuvant cancer chemotherapy with mitomycin C. Between June 1983 and December 1986, 336 patients with gastric cancer from 31 institutes were enrolled in the study. The cohort was stratified randomly by the telephone method into two arms. Group A received 20 mg and 10 mg of mitomycin C per body intravenously (IV) on postoperative days 0 and 1, respectively, and then tegafur at 600 mg/body daily perorally (PO) from postoperative week 2 for 1 year. Group B also received 0.2 mg of mitomycin C per kg IV at 3, 6, 9, and 12 months after surgery. The background factors in groups A and B were essentially identical, and the adverse effects were tolerable in both groups. The total administered doses of mitomycin C were significantly higher in group B than in group A, according to the protocol. Although no significant differences were observed in the actuarial overall survival rates between groups A and B at stages II, III, and IV, favorable survival was observed in group B, which received histologically absolute curative resection. This dose-intensive adjuvant cancer chemotherapy would be useful for gastric cancer patients treated by histologically curative surgery. © 1994 Wiley-Liss, Inc.     

ERCC1对胃癌患者手术及化疗后生存预测的意义

Objective  

The aim of this study was to evaluate the effect of the excision repair cross-complementing (ERCC1) expression on survival in advanced gastric cancer patients who underwent surgical resection and treated with oxaliplatinbased adjuvant chemotherapy.     

Impact of adjuvant chemotherapy in the long-term outcome of patients with resected gastric cancer

BACKGROUND AND OBJECTIVES: We analyzed in a retrospective analysis whether adjuvant chemotherapy with mitomycin (MMC) alone or with Tegafur (TG) is associated with long-term survival benefit in resected gastric cancer. Other prognostic factors are compared. METHODS: From 1977 to 1998, 314 consecutive totally resected gastric adenocarcinoma patients have been included in a survival study. In 151 patients no adjuvant therapy was given. In 163 patients, four courses of adjuvant chemotherapy was given, 109 of them with MMC, 10-20 mg/m(2) i.v. every 6 weeks and the other 54 with MMC plus TG, 500 mg/m(2) p.o. day for 42 consecutive days. Univariate and multivariate survival analyses were performed. RESULTS: Survival benefit was seen in patients who had received adjuvant chemotherapy compared with the controls (52% vs. 30% alive at the end of the study, relative risk = 0.46, 95% CI: 0.33-0.62, P < 0.0001), women (52% vs. 35%, RR = 0.83, 95% CI: 0.71-0.98, P = 0.0342) and increment of staging IB, II, IIIA, or IIIB (80, 56, 24 vs. 13%, respectively, RR = 1.83, 95% CI: 1.42-2.35, P < 0.0001). Better prognosis of node-negative patients was observed only in univariate analysis. CONCLUSIONS: After curative surgery, adjuvant chemotherapy with mitomycin C, both alone or combined with Tegafur, improved the long-term cure rate over no postoperative chemotherapy in locally advanced gastric cancer patients. This benefit was not influenced by other prognostic factors.     

Expression of thymidylate synthase in gastric cancer patients treated with 5-fluorouracil and doxorubicin-based adjuvant chemotherapy after curative resection

We evaluated the expression of thymidylate synthase (TS) in locally advanced gastric cancer patients treated with adjuvant chemotherapy after curative resection and investigated the association between TS expression and clinicopathologic characteristics including prognosis of the patients. TS expression was evaluated by immunohistochemical staining using TS106 monoclonal antibody in 103 locally advanced gastric cancer patients (stage IB-IV) who underwent 5-fluorouracil (5-FU) and doxorubicin-based adjuvant chemotherapy after curative resection. 65 patients (63%) had primary tumours with high TS expression (> or = 25% of tumour cells positive), and 38 patients (37%) demonstrated low TS expression (< 25% of tumour cells positive or no staining). High TS expression was associated with male gender (P = 0.002), poorly differentiated histology (P = 0.015), and mixed type in Lauren's classification (P = 0.027). There were no statistically significant differences in 4-year disease-free survival (60.0% vs. 57.2%, P = 0.548) and overall survival (59.6% vs. 59.3%, P = 0.792) between high-TS group and low-TS group. In conclusion, although high TS expression was associated with poorly differentiated histology and mixed type in Lauren's classification, it did not predict poor disease-free and overall survival in gastric cancer patients treated with 5-FU and doxorubicin-based adjuvant chemotherapy after curative resection. Further prospective studies including the evaluation of other biological markers associated with the resistance to 5-FU and doxorubicin are necessary.     

DOS方案辅助化疗对进展期胃癌的临床效果分析

目的 探讨进展期胃癌患者手术前给予多西他赛联合奥沙利铂和替吉奥(DOS)进行辅助化疗的临床疗效.方法 选取实施手术治疗的进展期胃癌患者88例进行回顾性分析,根据治疗方法不同将患者分为化疗组与单纯手术组,每组各44例.其中化疗组患者手术前给予DOS方案进行辅助化疗,单纯手术组患者仅行手术治疗.对比两组患者的手术情况、手术不良反应和远期生存情况.结果 化疗组44例患者中,有1例患者未能完成一个化疗周期,化疗的总有效率为95.35%;化疗组患者的术中出血量、阳性淋巴结数目均明显少于单纯手术组(P﹤0.001);化疗组患者的R0切除率高于单纯手术组(P﹤0.05);化疗组患者的术后2年复发率低于单纯手术组,2年生存率高于单纯手术组,但差异均无统计学意义(P﹥0.05).结论 术前DOS方案辅助化疗治疗进展期胃癌有利于提高肿瘤的手术根治性效果,有利于患者的远期生存获益.     

Efficacy of adjuvant chemotherapy after curative resection for gastric cancer: A meta-analysis of published randomised trials

Background:Several studies have investigated the possible roleof the adjuvant chemotherapy after curative resection for gastric cancerfailing to show a clear indication; previous meta-analyses suggested smallsurvival benefit of adjuvant chemotherapy, but the statistical methods usedwere open to criticisms. Materials and methods:Randomised trials were identified by meansof Medline and CancerLit and by selecting references from relevant articles.Systematic review of all randomised clinical trials of adjuvant chemotherapyfor gastric cancer compared with surgery alone, published before January 2000,were considered. Pooling of data was performed using the fixed effect model.Death for any cause was the study endpoint. The hazard ratio and its95% confidence intervals (95% CI), derived according to themethod of Parmar, were the statistics chosen for summarising the relativebenefit of chemotherapyversuscontrol. Results:Overall 20 articles (21 comparisons) were considered foranalysis. Three studies used single agent chemotherapy, seven combination of5-fluorouracil (5-FU) with anthracyclin, ten combination of 5-FU withoutanthracyclines. Information on 3658 patients, 2180 deaths, was collected.Chemotherapy reduced the risk of death by 18% (hazard ratio 0.82,95% CI: 0.75–0.89, P < 0.001). Association ofAnthracyclines to 5-FU did not show a statistically significant improvementwhen compared with the effect of the other regimens. Conclusions:Chemotherapy produces a small survival benefit inpatients with curatively resected gastric cancer. However, taking into accountthe limitations of literature based meta-analyses, adjuvant chemotherapy isstill to be considered as an investigational approach.     

不同术后辅助化疗方案对胃癌患者远期生存的影响

目的：比较奥沙利铂（L—OHP）联合5-FU／LV与羟基喜树碱（HCPT）联合5-FU／LV两种不同辅助化疗方案对可切除胃癌术后远期生存的影响。方法：85例I-Ⅳ期胃癌术后（R0切除）患者接受治疗,其中奥沙利铂组（L—OHP组）43例,羟基喜树碱组（HCPT组）42例,比较两组不良反应和生存率。结果：不良反应两组血小板减少、外周神经毒性及腹泻有显著性差异（P〈0．05）,其它不良反应无统计学差异（P〉0．05）。L—OHP组及HCPT组1、3、5年总生存率（OS）分别为95．4％、67．4％、18．6％和92．9％、64．3％、21．4％,两组比较无显著性差异（P〉Q05）,L—OHP组及HCPT组1、3、5年无病生存率（DFS）分别为83．7％、41．9％、9．3％和80．5％、45．2％、19．1％,随着时间延长,HCPT组5年DFS似有升高趋势,但均无统计学差异（P〉0．05）。结论：两种化疗方案均可作为胃癌患者术后辅助治疗的选择。