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。

DOX as neoajuvant chemotherapy in the treatment of adenocarcinoma of the esophagogastric junction and distal gastric cancer

Objective To explore the efficacy of neoadjuvant chemotherapy in the treatment of adenocarci- noma of the esophagogastric junction （AEG） and distal gastric cancer（DGC）. Methods From October 2008 to March 2011, 58 advanced operable patients gastric cancer in the General Surgery Department of Jiangsu Tumor Hospital received DOX as neoadjuvant chemotherapy before surgery, included 18 AEG patients and 40 DGC patients. Results In the AEG group, there were 3 CR cases, 12 PR cases, 3 SD cases, and 0 PD case and DGC group were 2 CR cases, 20 PR cases, 17 SD cases and 1 PD case. The total effective rate were 83.3%vs. 55.0% （P 〈0.05）. The R0 resection rate were 88.8% vs. 87.5% （P 〉0.05）. The most common side effects were granul ocytopenia, gastrointestinal tract adverse reaction and periphery neurotoxicity. There was no significant difference in the incidence of postoperative complications, one-year survival rates and two- year survival rate between the two groups. Conclusions The efficacy of DOX as neoadjuvant chemotherapy in the treatment of advanced gastric cancer especially AEG can reduce the tumor size and tumor stage, this finding that might help identify patients who would benefit from preoperative chemotherapy.