紫杉醇聯合奧沙利鉑為主的化療方案治療晚期胃癌的臨床觀察

何麗琳 沈永祥 許曉東

[摘要] 目的 觀察紫杉醇聯合奧沙利鉑為主化療方案治療晚期胃癌的臨床效果。 方法 將2010年1月～2012年12月湖北省天門市第一人民醫院腫瘤科72例胃癌晚期患者隨機分為兩組，每組36例。觀察組采用紫杉醇、奧沙利鉑和卡培他濱。對照組采用奧沙利鉑、氟尿嘧啶和醛氫葉酸化療。治療后評價療效、生活質量改變、不良反應以及治療前后的血清癌胚抗原（CEA）、糖抗原（CA-199）和β2微球蛋白（β2-MG）比較。 結果 觀察組完全緩解（CR）3例，部分緩解（PR）18例，總有效率（RR）為58.3%。對照組CR 2例，PR 15例，RR為47.2%。觀察組卡氏評分改善率（52.8%）高于對照組（41.6%）。觀察組主要不良反應骨髓抑制、惡心、嘔吐、脫發、肝功能損傷等方面均較對照組明顯減輕，治療后觀察組的血清CEA[（15.68±2.72）ng/mL]、CA-199[（69.58±4.72）μg/mL]和β2-MG[（3.27±0.61）ng/mL]較對照組下降，兩組比較差異均有統計學意義（P < 0.05）。 結論 紫杉醇聯合奧沙利鉑治療晚期胃癌具有提高化療有效率、減輕化療不良反應、提高患者生活質量的作用。

[關鍵詞] 紫杉醇；奧沙利鉑；胃癌晚期

[中圖分類號] R735.7 [文獻標識碼] A [文章編號] 1673-7210（2014）02（c）-0056-04

Clinical observation of Paclitaxel and Oxaliplatin-based chemotherapy regimens in the treatment of advanced gastric cancer

HE Lilin1 SHEN Yongxiang2 XU Xiaodong3

1.Department of Oncology， the First People's Hospital of Tianmen City， Hubei Province， Tianmen 431700， China； 2.Department of Digestive System， the First People's Hospital of Tianmen City， Hubei Province， Tianmen 431700， China； 3.Department of Digestive System， Zhejiang Provincial People's Hospital， Zhejiang Province， Hangzhou 310014， China

[Abstract] Objective To observe the efficacy of Paclitaxel combined with Oxaliplatin-based chemotherapy regimens in the treatment of patients with advanced gastric cancer. Methods 72 cases of advanced gastric cancer patients in Department of Oncology in the First People's Hospital of Tianmen City of Hubei Province from January 2010 to December 2012 were chosen and divided into two groups， with 36 cases in each group. Observation group were received Paclitaxel， Oxaliplatin and Capecitabine， while control group were treated with Oxaliplatin， Calcium Folinate combined with Fluorouracil. After therapy， the therapeutic effect， change of life quality and side effect were evaluated. Serum CEA， CA199 and β2-MG before and after treatment were compared. Results In observation group， 3 patients had complete response， 18 patients had partial response， the response rate was 58.3%. In control group， 2 patients had complete response， 15 patients had partial response， the response rate was 47.2%. The observation group KPS improvement rate （52.8%） was higher than that of control group （41.6%）. The untoward effect of observation group such as the arresting of bone marrow， nausea， vomit， alopecia and injury of liver function were all less than those of control group. Serum CEA [（15.68±2.72） ng/mL]， CA199 [（69.58±4.72） μg/mL] and β2-MG [（3.27±0.61） ng/mL] of the observation group after treatment were lower than those of control group， there were significant differences （P < 0.05）. Conclusion The Paclitaxel combined with Oxaliplatin for patients with advanced gastric cancer can increase the response rate， lighten the untoward effect of chemotherapy， and enhance the quality of life.

[Key words] Paclitaxel； Oxaliplatin； Advanced gastric cancer

胃癌是我國最常見的惡性腫瘤之一，幾乎接近全部惡性腫瘤死亡人數的1/4，并且每年還有2萬以上的人被確認為胃癌。因此，胃癌是一種嚴重威脅人民健康的疾病。對于，胃癌以往的治療方法是以化療為主，但是這種治療方法也只能維持胃癌患者的生命，并且花銷大，效果欠佳。因此，對于胃癌晚期的患者，了解和調查新的治療方案很重要。奧沙利鉑（OXA）作為第三代鉑類藥物，具有與順鉑（DDP）和卡鉑（CBP）不完全交叉耐藥，且OXA與氟尿嘧啶（5-Fu）具有協同作用，即使對5-Fu耐藥的患者也有效[1]。紫杉醇聯合化療方案有效率為22%～65%，中位生存期（MST）為6～14個月[2]，顯示了良好的抗腫瘤活性，本次試驗應用以紫杉醇和奧沙利鉑為主的聯合化療方案治療72例晚期胃癌的資料進行回顧性分析 。……