摘要
目的局部晚期胃癌术后放化疗是胃癌综合治疗的重要组成部分,既往研究中术后放化疗主要针对淋巴结阳性和浆膜层受侵,按照术后组织学类型Lauren分型因素来选择的研究较少,术后Lauren分型临床容易获得,增加Lauren分型因素指导术后放化疗的选择具有重要临床意义。本研究分析和比较Lauren分型中肠型和弥漫型在局部晚期胃癌术后放化疗中的临床疗效和不良反应,为胃癌术后放化疗临床应用提供指导。方法回顾性分析2012-05-10-2014-10-10江南大学附属医院肿瘤放疗科诊治的局部晚期胃癌患者80例,均接受D2根治术后放化疗,放化疗顺序为术后化疗2个周期后同期放化疗,放疗后辅助化疗4个周期,组织学按Lauren分型分为肠型组和弥漫型组各40例,放疗方法均为调强放疗(intensity modulated radiation therapy,IMRT)技术,放疗剂量为45Gy/25次。比较两组患者3年总生存率(overall survival,OS)、3年无瘤生存率(disease-free survival,DFS)和3年局部区域复发率(locoregional recurrence rate,LRR),以及两组不良反应及治疗后失败的分布情况。结果肠型组与弥漫型组3年OS分别为72.5%和50.0%,差异有统计学意义,χ2=4.270,P=0.039;3年DFS分别为65.0%和42.5%,差异有统计学意义,χ2=4.070,P=0.044;3年的LRR分别为12.5%和15.0%,差异无统计学意义,χ2=0.110,P=0.745;两组不良反应差异无统计学意义,主要不良反应是1~2级消化道反应,血液学毒性及手足综合征,两组失败表型中腹膜转移肠型组发生6例,弥漫型组发生13例;远处脏器转移肠型组发生4例,弥漫型组发生8例,弥漫型组发生腹膜转移及远处脏器转移较肠型组有所增加。结论局部晚期胃癌术后放化疗中肠型组较弥漫组3年OS和DFS明显延长,弥漫型组有远处转移倾向提示应加强全身治疗,Lauren分型对局部晚期胃癌术后放化疗选择有一定的指导作用,值得进一步研究。
OBJECTIVE Postoperative chemoradiotherapy for local advanced gastric cancer is an important part of comprehensive treatment of gastric cancer.In previous studies,postoperative chemoradiotherapy was mainly targeted at lymph node positive and serosal invasion.There are few studies on the selection of Lauren classification factors according to postoperative histological type,and Lauren classification of postoperation is easy to obtain.It has important clinical significance that increase Lauren classification factor to guide the selection of postoperative chemoradiotherapy.This study analyzed and compared the clinical efficacy and adverse reactions of different Lauren types of intestinal type group and diffuse type group in postoperative chemoradiotherapy for local advanced gastric cancer,which provide guidance for the clinical application of postoperative chemoradiotherapy.METHODS Retrospective analysis of patients with local advanced gastric cancer treated by D2 radical postoperative chemoradiotherapy,between May 10,2012 and October 10,2014 in Jiangnan University Affiliated Hospital Department of Oncological Radiotherapy.The sequence of chemoradiotherapy was concurrent chemoradiotherapy after 2 cycles of postoperative chemotherapy,4 cycles of adjuvant chemotherapy after radiotherapy.Histology was divided into two types：intestinal type group and diffuse type group.Each group collected 40 patients.The radiotherapy method was IMRT technology.Total dose was 45 Gy/25 times.The 3-years of overall survival（OS）,disease-free survival（DFS）,locoregional recurrence rate（LRR）,adverse reactions and the distribution of failure after treatment were mainly compared between the two groups.RESULTS The three years OS of intestinal type group and diffuse type group were 72.5% and 50.0% respectively,and the difference was statistically significant,χ2=4.270,P=0.039;the 3-years of DFS were 65.0% and 42.5% respectively,and the difference was statistically significant,χ2=4.070,P=0.044;the 3-years LRR were 12.5% and 15.0%,res
作者
张晓军
赵于天
张福正
王明智
杨波
周乐源
ZHANG Xiao-jun;ZHAO Yu-tian;ZHANG Fu-zheng;WANG Ming-zhi;YANG Bo;ZHOU Le-yuan(Department of Radiation Oncology,Affiliated Hospital of Jiangnan University（Wuxi NO.4 People＇s Hospital）,Wuxi 214062,P.R.China)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2018年第14期1013-1018,共6页
Chinese Journal of Cancer Prevention and Treatment
关键词
局部晚期胃癌
术后放化疗
Lauren分型
疗效
local advanced gastric cancer
postoperative chemoradiotherapy
Lauren classification
efficacy
