本文選題：食管胃結(jié)合部腺癌　切入點(diǎn)：輔助化療　出處：《皖南醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:胃癌和食管胃結(jié)合部腫瘤(Carcinoma of Esophagogastric Junction,CEG)是一種具有高度侵襲性的消化系統(tǒng)惡性腫瘤,是全世界癌癥相關(guān)死亡第三大常見原因。全世界胃癌的發(fā)病率逐漸減少,但CEG的發(fā)病率在穩(wěn)步增加。CEG從病理學(xué)角度上主要包含食管下段鱗癌以及食管胃結(jié)合部腺癌(Adenocarcinoma of Esophagogastric Junction,AEG)兩種類型,有將近50%的患者在初診時(shí)即診斷為局部晚期,且預(yù)后不良,盡管行R0根治性切除術(shù)后病人的五年生存率也達(dá)不到20%。關(guān)于胃癌大量的輔助和新輔助治療已經(jīng)證明相比于單獨(dú)手術(shù)治療改善了約15%的生存。關(guān)于AEG的治療方案選擇至今仍存在不少爭(zhēng)議。本文主要是回顧性分析AEG術(shù)后輔助化療的相關(guān)研究,比較SOX(奧沙利鉑聯(lián)合替吉奧)方案與PF(順鉑聯(lián)合5-氟尿嘧啶)方案治療AEG根治術(shù)后患者的療效以及安全性,從而探討更適于AEG患者的化療方案。方法:回顧性分析2010年10月-2013年10月在解放軍第105醫(yī)院行AEG根治術(shù)后病理分期為Ⅲ期,接受SOX方案和PF方案化療的患者共76例,其中SOX方案組38例,PF方案組38例,比較兩組患者的無病生存期(Disease-Free Survival,DFS)、總生存期(Overall Survival,OS)以及化療不良反應(yīng)。生存時(shí)間采用Kaplan-Meier法和Log rank檢驗(yàn)進(jìn)行生存分析,率的比較采用卡方檢驗(yàn),不良反應(yīng)分級(jí)按照美國(guó)國(guó)立癌癥研究所常見毒性分級(jí)標(biāo)準(zhǔn)3.0版(National Cancer Institute Common Toxicity Criteria Version 3.0,NCI-CTC v3.0)進(jìn)行評(píng)估。結(jié)果:1.SOX組中位DFS為33.2個(gè)月,PF組中位DFS17.8個(gè)月,SOX組高于PF組,有顯著統(tǒng)計(jì)學(xué)差異(χ~2=18.918,P0.001)。2.SOX組中位OS為39.3個(gè)月,PF組中位OS23.4個(gè)月,SOX組高于PF組,有顯著統(tǒng)計(jì)學(xué)差異(χ~2=24.789,P0.001)。3.SOX組與PF組毒副反應(yīng)主要是骨髓抑制和消化道反應(yīng),如白細(xì)胞及中性粒細(xì)胞減少,貧血,惡心、嘔吐,以Ⅰ~Ⅱ度為主。SOX組與PF組白細(xì)胞減少發(fā)生率分別為44.7%、65.8%,貧血發(fā)生率分別為36.8%、55.3%,血小板減低發(fā)生率分別為7.9%、10.5%,肝功能損傷發(fā)生率分別為15.8%、18.4%,腎功能損傷發(fā)生率分別為7.9%、15.8%,以上均無明顯統(tǒng)計(jì)學(xué)差異(P0.05)。兩組中性粒細(xì)胞減少發(fā)生率分別占39.5%、65.8%,有顯著統(tǒng)計(jì)學(xué)差異(χ~2=5.278,P=0.022);兩組惡心嘔吐發(fā)生率分別為42.1%、65.8%,有顯著統(tǒng)計(jì)學(xué)差異(χ~2=4.290,P=0.038)。SOX方案組外周神經(jīng)系統(tǒng)毒性發(fā)生率較PF方案組高,有顯著統(tǒng)計(jì)學(xué)差異(χ~2=10.050,P=0.002),但均在可耐受范圍內(nèi)。結(jié)論:SOX作為AEG患者根治術(shù)后輔助化療方案,同PF方案相比,患者的中位DFS及OS均延長(zhǎng),毒副反應(yīng)均可耐受,具有明顯優(yōu)勢(shì),為下一步進(jìn)行大樣本的臨床試驗(yàn)提供了依據(jù)。
[Abstract]:Objective: carcinoma of Esophagogastric JunctionCegor is a highly invasive malignant tumor of the digestive system and is the third most common cause of cancer-related death in the world.Nearly 50% of the patients were diagnosed locally late at first visit and had poor prognosis, although the 5-year survival rate of patients after R0 radical resection was less than 20%.A large number of adjuvant and neoadjuvant treatments for gastric cancer have been shown to improve survival by about 15% compared to surgery alone.The choice of treatment for AEG is still controversial.The purpose of this study was to retrospectively analyze the related studies of adjuvant chemotherapy after AEG, and to compare the efficacy and safety of SOX (oxaliplatin combined with teguio) regimen and PF- (cisplatin combined with 5-fluorouracil) regimen in the treatment of patients with AEG after radical operation.To explore a more suitable chemotherapy regimen for patients with AEG.Methods: from October 2010 to October 2013, 76 patients were treated with SOX regimen and PF regimen, including 38 cases of SOX regimen group, 38 cases of PF regimen group, and the pathological stage 鈪，

本文編號(hào)：1706582