EOX方案术前治疗局部进展期可切除胃癌的临床疗效及安全性

目的:探讨EOX方案术前治疗局部进展期可切除胃癌患者的临床疗效及安全性。方法:纳入2014年12月至2018年6月在我院腹部外科接受EOX方案术前化疗后行手术治疗的50例cT3N0M0-cT4bN3M0期的胃癌患者的临床资料，分析临床疗效及毒副反应。结果:45例患者的数据可用于分析，其中13例（28.9%）患者达完全缓解（CR），10例（22.2%）患者达部分缓解（PR），22例（48.9%）患者处于病灶稳定状态（SD），未出现病情进展的病例，疾病控制率（CR+PR+SD）达100%，客观缓解率（CR+PR）为51.1%。3个周期化疗后行D2淋巴结清扫的胃癌根治手术，39例（86.7%）患者达到R0切除，6例（13.3%）患者为R1切除。术后进行病理退缩分级（TRG），10例（22.2%）完全退缩（0），6例（13.3%）中等退缩（1），17例（37.8%）轻微退缩（2），12例（26.7%）无退缩（3）。化疗过程中无化疗相关死亡病例。化疗期间发生的毒副反应主要为恶心呕吐、血液学毒性、神经毒性、脱发等，其中恶心总发生率为84%，呕吐总发生率为44%，3、4级恶心呕吐反应发生率为13.3%。血液学毒性反应中，白细胞减少总发生率为57.8%，3、4级白细胞减少为8.9%。神经毒性及脱发毒副反应发生率较高，分别为55.6%与91.1%，其3、4级毒副反应发生率分别为2.2%与17.8%。均经对症处理后症状缓解。手术R0切除率为86.7%，术后并发症发生率为4.4%。截止2019年8月，1年生存率为93.3%。结论:EOX方案术前治疗局部进展期胃癌具有较好疾病控制率和病理反应率，可提高R0手术切除率，不增加术后并发症，通过个体化剂量调整，毒副反应可控，值得进一步临床研究。

Clinical efficacy and safety of preoperative treatment for locally advanced resectable gastric cancer with EOX regimen

Objective:To investigate the clinical effects and safety of preoperative treatment for locally resectable advanced gastric cancer with EOX regimen.Methods:From December 2014 to June 2018,clinical data of 50 patients with advanced gastric cancer who received preoperative chemotherapy with EOX regimen and underwent surgical treatment in the abdominal surgery department of our hospital were included to analyze the clinical efficacy and side effects.Results:Data from 45 of the 50 enrolled patients were available for analysis,among which 28.9%（13/45) patients achieved complete response（CR),22.2%（10/45) patients achieved partial response（PR),48.9%（22/45) patients were in stable disease（SD),no cases of progressive lesion appeared.Disease control rate（CR+PR+SD) reached 100%.Objective response rate（CR+PR) was 51.1%.Radical gastrectomy with D2 lymph node dissection was performed after 3 cycles of chemotherapy.86.7%（39/45) patients achieved R0 resection,and 13.3%（6/45) patients achieved R1 resection.Postoperative pathological regression grading（TRG) was performed in 22.2%（10/45) patients with complete regression（0),13.3%（6/45) patients with moderate regression（1),37.8%（17/45) patients with mild regression（2),and 26.7%（12/45) patients without regression（3).No chemotherapy-related deaths occurred during the chemotherapy.During the chemotherapy,the main side effects were nausea and vomiting,hematological toxicity,neurotoxicity,hair loss,of which the total incidence of nausea was 84%.The total incidence of vomiting was 44%,and grade 3 and 4 nausea and vomiting reactions were 13.3%.The total incidence of leukopenia and grade 3 and 4 leukopenia was 57.8% and 8.9%,respectively.The incidence of neurotoxicity and hair loss were 55.6% and 91.1%,respectively,and the incidence of grade 3 and grade 4 adverse reactions were 2.2% and 17.8%,respectively.All of the above adverse reactions were relieved after positive symptomatic treatment.The R0 resection rate was 86.7% and the incidence of postoperative complications was 4.4%.By August 2019,the 1-year survival rate was 93.3%.Conclusion:The preoperative treatment of locally advanced gastric cancer with EOX regimen has a significant disease control rate and pathological response rate,which can improve the R0 surgical resection rate without increasing postoperative complications.The side effects can be controlled through individualized dose adjustment,which is worthy of further clinical study.