符涛　步召德　李子禹　武爱文　张霁　吴晓江　张连海　季鑫　季加孚



胃上部癌术前放化疗的有效性及安全性分析

符涛步召德李子禹武爱文张霁吴晓江张连海季鑫季加孚

摘要目的：探讨进展期胃上部癌术前放化疗的短期有效性、治疗安全耐受性及生存预后情况。方法：回顾性分析北京大学肿瘤医院胃肠肿瘤外科2011年11月至2014年11月间收治的行术前放化疗或术前化疗并后续标准D2根治手术的62例进展期胃上部癌患者病历资料，分析比较两组患者各项短期疗效指标、安全性指标及不良反应的差异，并进行随访资料的生存分析。结果：术后病理结果中术前放化疗组pT4期及pN3患者数量明显减少（P<0.05），手术安全性及放化疗不良反应两组间差异无统计学意义，生存分析两组间差异无统计学意义。结论：术前放化疗可改良胃上部癌患者生存预后。相较于术前化疗，术前放化疗没有增加手术难度及风险，放化疗毒性在可控范围内。术前放化疗能有效提高局部控制率尤其是区域淋巴转移，其客观缓解率与术前化疗相当。但是，生存预后的最终结论仍有待于长期随访的进一步分析。

关键词胃上部癌术前放化疗有效性安全性

Preoperative chemoradiation therapy for upper gastric cancer: a retrospective study for its efficacy and safety

Tao FU, Zhaode BU, Ziyu LI, Aiwen WU, Ji ZHANG, Xiaojiang WU, Lianhai ZHANG, Xin JI, Jiafu JI
Correspondence to: Zhaode BU; E-mail: buzhaode@cjcrcn.org
Department of Gastrointestinal Surgery, Beijing Cancer Hospital & Institute, Peking University School of Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China

Abstract Objective: To investigate the efficacy, safety, and overall survival of advanced upper gastric cancer patients who received preoperative chemoradiation therapy. Methods: A total of 62 patients who received preoperative chemotherapy or chemoradiation therapy in the Department of Gastrointestinal Surgery of Beijing Cancer Hospital & Institute were retrospectively observed to determine the efficacy and safety and to perform survival analysis of preoperative chemoradiation therapy. Results: Results of the postoperative pathology showed that the number of patients with T4and N3stages was significantly lower in the preoperative chemoradiation therapy group than in the preoperative chemotherapy group (P<0.05). In addition, the differences between the two groups in terms of safety and toxicity were not significant (P≥0.05). Analysis also showed that the differences between the two groups in terms of survival were not significant (P≥0.05). Conclusion: Patients with advanced upper gastric cancer can gain a potential survival advantage from preoperative chemoradiation therapy. Compared with preoperative chemotherapy, preoperative chemoradiation therapy was performed without increased risk of toxicity and insecurity. Preoperative chemoradiation therapy can also improve the local control ratio, especially the control ratio of lymphatic metastasis. However, the final results of survival analysis depend on long-term follow-up of patients.

Keywords:upper gastric cancer, preoperative chemoradiation therapy, efficacy, safety

根据世界卫生组织的报道，胃癌的发病率居于恶性肿瘤全球发病率的第5位，其死亡率更是高居第3位，仅次于肺癌与肝癌。中国每年胃癌新发病例占世界新发病例40%以上，相较于欧美地区相对较低的胃癌发病率及日韩地区相对较高的早期胃癌诊断率，我国对胃癌患者的诊治面临着十分严峻的形势。

胃上部癌病变范围包括食管胃结合部、胃底部，发病率逐年上升，其淋巴引流范围较为复杂，手术治疗涉及联合开胸、一定难度的消化道吻合重建及食管下段、膈肌、腹腔血管周围淋巴结清扫，单纯手术预后欠佳，因此对肿瘤局部控制有着较高的需求［1-3］。三维适形调强放射治疗技术的发展为胃上部癌的综合治疗带来了新的契机，考虑到放射治疗对肿瘤局部病灶较好的控制力和三维调强放疗的精准定位及较小的放疗损伤［4］，结合术前化疗对肿瘤微转移的抑制作用，术前联合放化疗成为了胃癌综合治疗新的研究热点［5］。……