本文選題：胃癌術(shù)后輔助化療　切入點(diǎn)：紫杉醇　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景與目的:胃癌是常見的消化系統(tǒng)惡性腫瘤之一,治療方法以手術(shù)為主,部分患者有完全治愈的可能,但術(shù)后復(fù)發(fā)是影響患者生存的重要因素。2006年一項(xiàng)關(guān)于圍手術(shù)期化療的III期臨床MAGIC研究表明術(shù)前術(shù)后應(yīng)用ECF方案比單獨(dú)手術(shù)的患者有更好的無進(jìn)展生存和總生存,該研究奠定了圍手術(shù)期化療的地位。2007年日本ACTS-GC研究顯示,胃癌D2根治術(shù)后替吉奧輔助化療比單純手術(shù)患者的總生存和無復(fù)發(fā)生存時(shí)間有延長趨勢(shì)。紫杉醇是胃癌的治療的常用藥,研究表明其與替吉奧聯(lián)合在晚期胃癌患者中顯示了較好療效,我們?cè)谂R床工作中發(fā)現(xiàn),紫杉醇聯(lián)合替吉奧(簡稱TS,Paclitaxel plus S-1)和奧沙利鉑聯(lián)合替吉奧(簡稱SOX,Oxaliplatin plus S-1)是胃癌化療中常用的方案,且紫杉醇常用于有高危因素的患者中,本研究應(yīng)用回顧性分析的方法,對(duì)比TS和SOX這兩種化療方案在胃癌術(shù)后輔助化療中的作用、中藥使用情況、復(fù)發(fā)轉(zhuǎn)移情況和不良反應(yīng)情況。方法:回顧性分析2009年9月至2015年10月之間行胃癌根治術(shù)后于大連醫(yī)科大學(xué)附屬第二醫(yī)院選用TS或SOX方案行輔助化療不少于3周期患者的臨床病例資料,均隨訪至2016年12月,所有病例均通過臨床病例資料或者電話隨訪,臨床數(shù)據(jù)用SPSS 22.0進(jìn)行分析,比較兩方案的無復(fù)發(fā)生存率(簡稱RFS率,Relapse--Free Survival Rate)和總生存率(簡稱OS率,Overall Survival Rate)、中藥使用情況、影響因素以及不良反應(yīng)情況,P小于0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1、共入組77例有完整隨訪資料的患者,TS組24人,SOX組53人,平均每人5.3個(gè)化療周期。77例患者1年RFS率和OS率為87.0%、96.1%,2年RFS率和OS率是70.5%、77.5%,3年RFS率和OS率為63.3%、67.3%;TS組和SOX組1年RFS率分別為83.3%和88.7%(P=0.269),1年OS率分別為91.7%和98.1%,(P=0.228),2年RFS率分別為68.8%和71.1%(P=0.859),2年OS率分別為62.5%和82.2%(P=0.107),3年RFS率分別為41.7%和74.3%(P=0.074),3年OS率分別為41.7%和75.7%(P=0.029);2、TS組和SOX組RFS均值為38.0個(gè)月、58.3個(gè)月(P=0.027),OS均值為41.1個(gè)月、62.3個(gè)月(P=0.057)。性別是術(shù)后RFS的獨(dú)立影響因素,P值為0.019,術(shù)后N分期是OS的獨(dú)立影響因素(P=0.020),余因素?zé)o統(tǒng)計(jì)學(xué)意義;3、對(duì)兩組患者1年RFS和OS進(jìn)行分層分析,在癌結(jié)節(jié)和神經(jīng)侵犯陽性的患者中,TS顯示了高于SOX方案的1年RFS率:100.0%VS 62.5%(P=0.491)、80.0%VS 75.0%(P=1.000),1年OS率:100.0%VS 87.5%(P=1.000)、100.0%VS 87.5%(P=0.152)。各個(gè)分層比較差異未見統(tǒng)計(jì)學(xué)意義;影響因素中:性別對(duì)1年RFS有影響(P=0.016),性別和腫瘤最大徑對(duì)1年OS有影響(P=0.016、P=0.033),余因素?zé)o統(tǒng)計(jì)學(xué)意義;4、TS組和SOX組復(fù)發(fā)轉(zhuǎn)移情況中,腹膜轉(zhuǎn)移(0.0%VS 1.9%)、盆腔轉(zhuǎn)移(12.5%VS 3.8%)、腹腔轉(zhuǎn)移(20.8%VS 13.2%)、肝轉(zhuǎn)移(0.0%VS 7.5%)、吻合口復(fù)發(fā)(0.0%VS 1.9%)、骨轉(zhuǎn)移(4.2%VS 0.0%)、腦轉(zhuǎn)移(4.2%VS 0.0%),腹膜后淋巴結(jié)轉(zhuǎn)移(12.5%VS 3.8%),兩組間差異無統(tǒng)計(jì)學(xué)意義;5、TS組和SOX組骨髓抑制和周圍神經(jīng)毒性發(fā)生率分別為:91.3%VS 73.4%(P=0.188)和25.0%VS 15.9%(P=0.385),TS組中性粒細(xì)胞降低多于SOX組(P=0.004),而SOX組化療血小板下降率多于TS組(P=0.020),白細(xì)胞減少、血紅蛋白減少、乏力、惡心嘔吐、食欲下降、肝功損傷、腹瀉兩組比較差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。TS組100%用使用中藥,SOX組96.2%使用中藥。結(jié)論:1、紫杉醇聯(lián)合替吉奧方案是胃癌根治術(shù)后輔助化療的有效方案之一,近期效果與奧沙利鉑聯(lián)合替吉奧方案相當(dāng),能使具有癌結(jié)節(jié)、神經(jīng)侵犯等高危因素的患者獲益,可能有助于降低肝轉(zhuǎn)移發(fā)生率。2、性別是胃癌術(shù)后RFS的獨(dú)立影響因素,術(shù)后N分期是OS的獨(dú)立影響因素;性別和腫瘤最大徑是術(shù)后1年OS的影響因素。3、紫杉醇聯(lián)合替吉奧方案骨髓抑制和周圍神經(jīng)毒性發(fā)生率略高于SOX,但無統(tǒng)計(jì)學(xué)意義;TS化療后中性粒細(xì)胞下降率高于SOX,SOX化療后血小板下降率高于TS;TS使用過程中是否應(yīng)加強(qiáng)中藥的使用有待進(jìn)一步對(duì)照研究。
[Abstract]:Background and objective: gastric carcinoma is one of the most common malignant tumor of digestive system, surgery is the main method for treatment, some patients have completely cured, but recurrence is.2006 important factors for patient survival in a perioperative chemotherapy clinical phase III MAGIC study showed that preoperative and postoperative application of ECF regimen alone surgical patients have better progression free survival and overall survival, the study laid the status of perioperative chemotherapy in.2007 Japan ACTS-GC study showed that radical resection of gastric cancer after D2 S-1 adjuvant chemotherapy in patients with surgery alone than the overall survival and recurrence free survival time prolonged trend. Paclitaxel is a commonly used drug in the treatment of gastric cancer. Research shows that with the S-1 combined in patients with advanced gastric cancer showed better curative effect, we found that in clinical work, paclitaxel combined with S-1 (TS Paclitaxel, plus S-1) and Osage Eybridge combined with S-1 (SOX Oxaliplatin, plus S-1) is commonly used in chemotherapy of gastric cancer, and paclitaxel used in patients with high risk factors, based on the retrospective analysis method, comparison of TS and SOX these two kinds of chemotherapy adjuvant chemotherapy in postoperative gastric cancer, traditional Chinese medicine usage. Recurrence and adverse events. Methods: a retrospective analysis from September 2009 to October 2015 between the lines of gastric cancer after radical operation in the Second Affiliated Hospital of Dalian Medical University with TS or SOX scheme for not less than 3 cycles of adjuvant chemotherapy in patients with clinical data, were followed up until December 2016, all cases were by clinical data or telephone follow-up, the clinical data of 22 SPSS is used to analyze the recurrence free survival rate of the two plan (hereinafter referred to as the RFS Relapse--Free Survival rate, Rate) and overall survival rate (OS, Overall Survival Rat e),涓嵂浣跨敤鎯呭喌,褰卞搷鍥犵礌浠ュ強(qiáng)涓嶈壇鍙嶅簲鎯呭喌,P灝忎簬0.05涓哄樊寮傛湁緇熻瀛︽剰涔，

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