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目的本研究探讨多西他赛联合奥沙利铂±替吉奥用于局部晚期不可切除的老年低分化胃癌患者的安全性及有效性。方法回顾性分析2009年12月至2013年8月期间在本院接受化疗的局部晚期不可切除老年低分化胃癌患者的临床资料,共54例(其中男36例,女18例),中位年龄70.9岁(65~80岁),有55.6%(30/54)的患者年龄调节的Charlson指数>3。54例患者包括29例接受多西他赛联合奥沙利铂方案化疗以及25例患者在多西他赛联合奥沙利铂方案基础上加用替吉奥,直至疾病进展或不能耐受,每2个周期进行疗效及安全性评价。结果 54例患者平均完成4.8个化疗周期,两药化疗组和三药化疗组的客观缓解率(ORR)分别为37.9%、36.0%,临床获益率(CBR)分别为65.5%、72.0%,两组TTP分别为8.4个月和8.6个月,OS分别为12.9个月和15.3个月,以上数据均无统计学差异(P>0.05)。Charlson≤3与Charlson>3的两组患者中位OS分别为15.6个月和12.9个月,Charlson>3患者中位OS与Charlson≤3患者相比较短,并且有统计学差异(P=0.013)。54例患者的不良反应均可耐受,主要为骨髓抑制、脱发、胃肠道反应和乏力,大多为Ⅰ~Ⅱ度,Ⅲ~Ⅳ度少见。三药化疗组患者在骨髓抑制、乏力、胃肠道反应方面多于两药化疗组,差异有统计学意义(P<0.05)。与Charlson≤3患者相比,有更高比例的Charlson>3者发生Ⅲ或Ⅳ级不良反应。结论对于晚期不可手术切除的低分化老年胃癌患者应给予积极的化疗,延长生存时间,两药联合方案治疗疗效并不差于三药方案,并且不良反应可耐受,更适合老年患者,值得进一步研究。
Objectives This study was to investigate the safety and efficacy of docetaxel plus oxaliplatin ± tegliolaide in patients with locally advanced unresectable gastric cancer. Methods The clinical data of 54 patients (36 males and 18 females) with locally advanced unresectable elderly patients with locally advanced gastric cancer undergoing chemotherapy in our hospital from December 2009 to August 2013 were retrospectively analyzed. The median age Age-adjusted Charlson Index in 70.9 years (65-80 years) and 55.6% (30/54) patients> 3.54 patients included 29 patients receiving docetaxel plus oxaliplatin regimen and 25 patients at Docetaxel combined with oxaliplatin program based on the addition of tonic, until the disease progresses or can not tolerate, the efficacy and safety evaluation every 2 cycles. Results The 54 patients completed an average of 4.8 cycles of chemotherapy. The objective response rates (ORR) were 37.9% and 36.0% in the two-drug and three-drug groups respectively. The clinical benefits rates (CBRs) were 65.5% and 72.0% The two groups of TTP were 8.4 months and 8.6 months, OS was 12.9 months and 15.3 months, the above data were no significant difference (P> 0.05). The median OS was 15.6 months and 12.9 months for both groups with Charlson≤3 and Charlson> 3, respectively. The median OS was shorter in Charlson> 3 patients than in Charlson≤3 patients (P = 0.013) . Adverse reactions of 54 patients were tolerable, mainly myelosuppression, hair loss, gastrointestinal reactions and fatigue, mostly Ⅰ ~ Ⅱ degrees, Ⅲ ~ Ⅳ degrees rare. The patients in the three-drug chemotherapy group had more bone marrow suppression, fatigue and gastrointestinal reactions than the two chemotherapy groups (P <0.05). Compared with Charlson ≤ 3 patients, a higher proportion of Charlson> 3 occurred grade Ⅲ or Ⅳ adverse reactions. Conclusion In patients with poorly differentiated gastric cancer with advanced gastric cancer who can not be surgically advanced, aggressive chemotherapy should be given to prolong the survival time. The efficacy of the two-drug combination regimen is not worse than that of the three-drug regimen, and the adverse reactions are tolerable and more suitable for elderly patients. the study.