白蛋白结合型紫杉醇联合替吉奥治疗胃癌腹膜转移的疗效分析

目的：探讨白蛋白结合型紫杉醇联合替吉奥（AS方案）治疗胃癌腹膜转移的疗效。方法：回顾性分析2018年9月至2019年12月复旦大学附属中山医院和上海市徐汇区中心医院收治的18例胃癌伴腹膜转移患者予AS方案治疗的疗效,其中10例中-大量腹水患者仅起病时予以穿刺抽液并腹腔注药1次。AS具体方案：一线治疗采用第1天和第8天白蛋白结合型紫杉醇125 mg/m²,第1天至第14天替吉奥80 mg/m²分2次口服,每3周治疗1次。化疗6次后若无疾病进展,予以白蛋白结合型紫杉醇或替吉奥交替维持治疗。每2个月复查CT进行疗效评估和生存随访。结果：男性10例,女性8例,中位年龄58.5岁,中位无进展生存时间（progression free survival,PFS）为（10.00±2.51）个月,中位总生存时间（overall survival,OS）为（14.00±0.85）个月。客观有效率（objective response rate,ORR）为44.44%,疾病控制率（disease control rate,DCR）为77.78%。腹膜转移伴恶性腹水10例,有腹水和无腹水患者的中位PFS分别为（7.00±1.46）个月和（11.00±1.28）个月（P=0.43）。主要不良反应为手足综合征、脱发、腹泻和中性粒细胞下降。结论：AS方案一线治疗胃癌腹膜转移,疗效可期,耐受性良好。针对敏感位点予以精准治疗有助于延长生存时间。

Efficacy analysis of combined albumin-bound paclitaxel with tegaful regimen in gastric cancer patients with peritoneal metastasis as first-line treatment

Objective:To explore the efficacy of albumin-bound paclitaxel (Abraxane) combined with tegafur (S-1) in the treatment of peritoneal metastasis of gastric cancer.Methods:Clinical data of 18 gastric cancer patients with peritoneal metastasis admitted to Zhongshan Hospital, Fudan University and Xuhui District Central Hospital of Shanghai from September 2018 to December 2019 and treated by AS (Abraxane plus S-1) regimen were retrospectively analyzed, and 10 patients with middle-large ascites were treated by abdominocentesis and intraperitoneal injection only once. All patients were treated with AS (Abraxane plus S-1) regimen during their first-line treatment. Abraxane (125 mg/m², d1 and d8) and S-1 (80 mg/m², bid, d1-14) were administered every 3 weeks. If no disease progression occurred after 6 cycles of chemotherapy, Abraxane and S-1 would be administered alternately as a subsequent maintenance treatment. CT evaluation and regular follow-up were conducted every 3 months.Results:Totally, 10 males and 8 females were enrolled with a median age of 58.5 years. The median progression-free survival (PFS) time and overall survival (OS) time was (10.00±2.51) months and (14.00±0.85) months, respectively. Meanwhile, the overall response rate (ORR) and disease control rate (DCR) of these patients was 44.44% and 77.78%, respectively. There were 10 patients with peritoneal metastasis and malignant ascites. The median PFS of patients with or without ascites was (7.00±1.46) months and (11.00±1.28) months, respectively (P=0.43). The main adverse events were hand-foot syndrome, alopecia, diarrhea, and neutropenia.Conclusion:AS regimen exhibited promising efficacy and well tolerance in first-line treatment of gastric cancer patients with peritoneal metastasis. Precise treatment against specific target might prolong survival time.