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。

Value of normalization window of tumor vasculature in neoadjuvant chemotherapy for patients with unresectable gastric cancer

Objective To evaluate the value of normalization window of tumor vasculature （NWTV） in patients with unresectable gastric cancer undergoing neoadjuvant chemotherapy. Methods From October 2010 to March 2011, 93 patients with unresectable advanced or locally advanced gastric carcinoma were prospectively collected and randomly divided to Group A （n=30）, Group B （n=29）, and Group C （n=34）. Group A received FOLFOX4 as conventional neoadjuvant chemotherapy. Group B received FOLFOX4 plus bevacizumab. The treatment was adjusted in Group C according to the hypothesis of NWTV with neoadjuvant chemotherapy delivered 5 days after bevacizumab treatment. The efficacy, drug toxicity and clinical outcome were assessed and compared between the three groups. Results There were no significant differences among the 3 groups in demographics （P〉0.05）. All the patients completed the neoadjuvant chemotherapy. Efficacy and toxicity between the three groups were comparable （P〉0.05）. The rates of tumor downstaging in the three groups were 56.7%（17/30）, 72.4% （21/29）, 85.3% （29/34）, respectively, with a significantly lower downstaging rate in Group C as compared to Group A （P〈O.05）. R0 resection rates were 23.3%（7/30）, 27.6%（8/29）, 52.9% （18/34）, respectively, with significantly higher R0 resection rate in Group C as compared to Group A and Group B （All P〈0.05）. There was no perioperative death in this cohort. Postoperative complications were comparable among the 3 groups （P〉0.05）. Conclusions Anti-angiogenesis agentcan improve the efficacy of neoadjuvant chemotherapy in unresectable gastric cancer. Furthermore, administration according to NWTV may achieve better outcomes.