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目的评价紫杉醇联合顺铂、替加氟方案新辅助化疗在治疗进展期胃癌的临床疗效及安全性。方法 41例进展期胃癌患者给予紫杉醇联合顺铂、替加氟方案新辅助化疗(新辅助化疗组),并以同期常规直接手术的52例患者做对照(常规手术组),观察新辅助化疗的毒副作用和所有患者手术的R0切除率、D2的淋巴结清扫率情况及术后1年无病生存率。结果新辅助化疗的有效率为59%(24/41),疾病控制率为93%(38/41)。Ⅲ/Ⅳ度毒副作用主要为白细胞减少及呕吐。新辅助化疗组中34例(83%)行胃癌D2根治术,35例(85%)患者获得R0切除,淋巴结转移率≤30%者33例,淋巴结转移率>30%者8例,1年无病生存率为95%;对照组中,31例(60%)行D2根治术,36例(69%)患者获得R0切除,淋巴结转移率≤30%者28例,淋巴结转移率>30%者24例,1年无病生存率80%。2组1年无病生存率、D2根治术成功率及淋巴结转移率差异均有统计学意义(P<0.05)。2组间R0切除率差异无统计学意义。结论紫杉醇联合顺铂、替加氟方案新辅助化疗患者的耐受性和依从性好,有效率高,并可提高进展期胃癌患者的D2手术切除率、降低淋巴结转移率,并可提高患者1年无病生存率。
Objective To evaluate the clinical efficacy and safety of neoadjuvant chemotherapy with paclitaxel plus cisplatin and tegafur in the treatment of advanced gastric cancer. Methods Forty-one patients with advanced gastric cancer were treated with paclitaxel combined with cisplatin and tegafur solution neoadjuvant chemotherapy (neoadjuvant chemotherapy). The control group (n = 52) was given conventional neoadjuvant chemotherapy (routine surgery group) Side effects and R0 resection rate in all patients, lymph node dissection rate in D2 and 1-year disease-free survival rate after surgery. Results The effective rate of neoadjuvant chemotherapy was 59% (24/41) and the disease control rate was 93% (38/41). Ⅲ / Ⅳ degree of toxicity mainly for leukopenia and vomiting. In the neoadjuvant chemotherapy group, 34 patients (83%) underwent radical gastrectomy for D2, and 35 patients (85%) had R0 resection. There were 33 patients with lymph node metastasis ≤30%, 8 patients with lymph node metastasis> 30% In the control group, 31 patients (60%) underwent D2 radical mastectomy and 36 patients (69%) had R0 resection, the rate of lymph node metastasis was less than 30%, the rate of lymph node metastasis was 30% 24 cases, 1 year disease-free survival rate of 80%. The 1-year disease-free survival rate, success rate of D2 radical operation and lymph node metastasis rate in two groups were statistically significant (P <0.05). R0 resection rate between the two groups showed no significant difference. Conclusion paclitaxel combined with cisplatin, tegafur neoadjuvant chemotherapy patients with good tolerance and compliance, high efficiency, and can improve the rate of D2 resection in patients with advanced gastric cancer surgery to reduce the rate of lymph node metastasis, and can improve patients with 1 Disease-free survival rate.