目的 比较3种常用联合化疗方案一线治疗晚期胃癌的临床疗效和安全性. 方法 回顾性研究2010年1月至2013年6月期间一线接受联合化疗的晚期胃癌患者46例.其中奥沙利铂联合氟尿嘧啶(mFOLFOX6)方案治疗14例;伊立替康联合氟尿嘧啶(FOLFIRI)方案治疗12例;多西他赛、奥沙利铂或顺铂联合氟尿嘧啶(DOF/DCF)方案治疗20例.化疗2月后评价疗效,化疗期间监测药物不良反应,对无进展生存时间(PFS)和总生存期(OS)进行随访. 结果 3种联合化疗的总体客观缓解率为23.9％,总体疾病控制率为82.6％.mFOLFOX6、FOLFIRI、DOF/DCF治疗的患者中位OS分别为20月、11.5月和26月(P=0.043).分层分析显示对于复发后一线治疗的患者,3种化疗方案没有统计学差异,而对于初治的患者,一线使用FOLFIRI或mFOL-FOX6或DOF/DCF的PFS分别为2.5月、5.5月和7月,中位OS分别为4.5月、19月和14月(P=0.020).全部Ⅲ～Ⅳ度药物不良反应发生率在mFOLFOX6组(21.4％)较低,但无统计学差异. 结论 3种化疗方案用于晚期胃癌均有效且可耐受,但对于初治患者mFOLFOX6或DOF/DCF较FOLFIRI具有更多的生存获益.%Objective To investigate the clinical efficacy and safety of commonly used combination chemotherapy in the treatment of advanced gastric cancer patients.Methods Forty-six patients with advanced gastric cancer were recruited in this retrospective study.Fourteen cases received first-line combination chemoregimen of mFOLFOX6,12 receiving FOLFIRI,and 20 receiving DOF/DCF.Clinical response was evaluated after two months of treatment.Drug-related toxicity was monitored during chemotherapy.Progression-free survival time (PFS) and overall survival time (OS) were recorded.Results The overall objective response rate was 23.9％ and the overall disease control rate was 82.6％.The median OS for mFOLFOX6,FOLFIRI or DOF/DCF treated patients were 20 months,11.5 months and 26 months (P=0.043),respectively.Stratified analysis showed that,for patients receiving first-line therapy at disease recurrence,there was no significant difference in PFS or OS when comparing the three regimens.However,for patients receiving chemotherapy at the time of diagnosis,the median PFS and OS for mFOLFOX6,FOLFIRI or DOF/DCF treated patients were 5.5 months,2.5 months,7 months,and 19 months,4.5 months,14 months (P =0.020),respectively.The incidences of all Ⅲ-Ⅳ degree toxicities were comparatively lower in the patients treated with mFOLFOX6 (21.4％).Conclusions These three regimens are effective with acceptable toxicities as first line therapy for advanced gastric cancer.mFOLFOX6 or DOF/ DCF has more survival benefit than FOLFIRI for patients receiving first-line chemotherapy at the time of diagnosis.
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