不同化疗方案(PCF vs OLF)治疗晚期胃癌的疗效及安全性评价

背景与目的：化学治疗可提高晚期胃癌患者的生活质量,延长生存期,但胃癌化疗方案众多,目前尚无“金标准”可循。本研究对61例晚期胃癌分别施以紫杉醇＋顺铂（DDP）＋氟尿嘧啶（5-FU）（PCF）方案或草酸铂＋亚叶酸钙（LV）／5-FU（OLF）方案化疗,探讨不同方案的化疗疗效、不良反应及预后的影响因素。方法：61例晚期胃癌患者分两组,分别接受PCF方案（紫杉醇135mg／m^2,第1天;DDP15mg/m^2,第1～5天;5-FU500mg／m^2,第1～5天;每21d重复）,或OLF方案（草酸铂130mg/m^2,第1天;LV200mg／m^2,第1～5天;5-FU750mg／m^2．第1～5天;每21d重复）3～6个周期,然后对所有患者进行随访至死亡为止。结果：PCF组有效率为51．6％（16／31）,OLF组有效率为33．3％（10／30）,两组近期疗效差异无显著性（P=0．209）,PCF和OLF组的中位肿瘤进展时间（TTP）均为8个月（P=0．414）,而前者的中位总生存期（OS）14个月,略优于后者（13个月）,但差异无显著性（P=0．300）;PCF组的白细胞减少发生率达80％（22／31）,显著高于OLF组（43．3％,P=0．033）,而OLF组的外周神经炎发生率显著高于PCF组（P〈0．001）。单因素生存分析提示女性、临床分期Ⅳ期、近期疗效较差者的预后不佳,而多因素生存分析显示,近期疗效是决定晚期胃癌TTP和OS的唯一独立预后因素。结论：PCF和OLF两种方案治疗晚期胃癌,近、远期疗效相近而耐受性较好,而化疗的近期疗效是晚期胃癌患者TTP和OS的独立预后因素。

The evaluation of efficacy and safety of different combined chemotherapy regimen (PLF vs. OLF) for patients with late-stage gastric carcinoma

Background and purpose:Chemotherapy could improve quality of life and prolong the survival of patients with late-stage gastric carcinoma.No "golden standard" regimen is to set up nowadays,although there are numerous chemotherapy regimens available.Sixty-one patients with late-stage gastric cancer received either paclitaxel,cisplatin and fluorouracil(PCF) chemotherapy,or oxaliplatin and LV/fluorouracil(OLF) chemotherapy in our hospital.Therefore,the efficacy,adverse reaction,and prognostic factors of two regimens were explored.Methods:Sixty-one patients were divided into two groups.PCF group received 3 to 6 cycles of PCF regimen(paclitaxel 135 mg/m~(2) d 1,cisplatin 15mg/m~(2) d 1-5,fluorouracil 500 mg/m~(2) d 1-5,once every 21 days),and OLF group received regimen(oxaliplatin 130 mg/m~(2) d 1,LV 200 mg/m~(2) d 1-5,fluorouracil 750 mg/m~(2) d 1-5,once every 21 days),respectively.The follow-up was carried on until all of the patient were deceased.Results:The response rate were 51.6%(16/31) in PCF group and 33.3%(10/30) in OLF group,respectively.There was no significant difference between immediate responses of two groups(P=0.209).The median time for tumor to progression(TTP) in PCF group and OLF group were both 8 months(P=0.414),and the overall survival(OS) of the PCF group was 14 months,which was slightly longer than the latter(13 months,P=0.300).The incidence rate of leukocytopenia in PCF group was 80%(22/31),compared to that in OLF group(43.3%,P=0.033),while the incidence rate of peripheral neuritis of OLF group is statistically higher than that of PCF group(P<0.001).Univariate survival analysis showed that female,the patients with IV stage or poor short-term response were negative prognostic factors.Multivariate survival analysis showed that the shortterm effect was the only independent prognostic factor for TTP and OS of the patients with late-stage gastric carcinoma.Conclusions:PCF and OLF regimens have similar short-and long-term effect and both were well tolerated for the treatment of late-stage gastric carcinoma.And the short-term effect of chemotherapy was the independent prognostic factor for TTP and OS in the patients with late-stage gastric carcinoma.