BACKGROUND:A regimen of epirubicin,cisplatin,and infused fluorouracil(ECF) improves survival among patients with incurable locally advanced or metastatic gastric adenocarcinoma.We assessed whether the addition of a pe...BACKGROUND:A regimen of epirubicin,cisplatin,and infused fluorouracil(ECF) improves survival among patients with incurable locally advanced or metastatic gastric adenocarcinoma.We assessed whether the addition of a perioperative regimen of ECF to surgery improves outcomes among patients with potentially curable gastric cancer.METHODS:We randomly assigned patients with resectable adenocarcinoma of the stomach,esophagogastric junction,or lower esophagus to either perioperative chemotherapy and surgery(250 patients) or surgery alone(253 patients) .Chemotherapy consisted of three preoperative and three postoperative cycles of intravenous epirubicin(50 mg per square meter of body-surface area) and cisplatin(60 mg per square meter) on day 1,and a continuous intravenous infusion of fluorouracil(200 mg per square meter per day) for 21 days.The primary end point was overall survival.RESULTS:ECF-related adverse effects were similar to those previously reported among patients with advanced gastric cancer.Rates of postoperative complications were similar in the perioperative-chemotherapy group and the surgery group(46 percent and 45 percent,respectively) ,as were the numbers of deaths within 30 days after surgery.The resected tumors were significantly smaller and less advanced in the perioperative-chemotherapy group.With a median follow-up of four years,149 patients in the perioperative-chemotherapy group and 170 in the surgery group had died.As compared with the surgery group,the perioperative-chemotherapy group had a higher likelihood of overall survival(hazard ratio for death,0.75;95 percent confidence interval,0.60 to 0.93;P = 0.009;five-year survival rate,36 percent vs.23 percent) and of progression-free survival(hazard ratio for progression,0.66;95 percent confidence interval,0.53 to 0.81;P < 0.001) .CONCLUSIONS:In patients with operable gastric or lower esophageal adenocarcinomas,a perioperative regimen of ECF decreased tumor size and stage and significantly improved progression-free and overall survival.展开更多
目的:探讨阿帕替尼用于二线及二线以上治疗失败的晚期胃癌患者的临床疗效分析及预后因素研究.方法:研究对象为2014-10/2015-08曾接受过二线及二线以上治疗失败的60例晚期胃癌患者,均经病理确诊.给予阿帕替尼口服850m g/d,直至疾病进展,...目的:探讨阿帕替尼用于二线及二线以上治疗失败的晚期胃癌患者的临床疗效分析及预后因素研究.方法:研究对象为2014-10/2015-08曾接受过二线及二线以上治疗失败的60例晚期胃癌患者,均经病理确诊.给予阿帕替尼口服850m g/d,直至疾病进展,观察临床疗效及不良反应发生情况.应用Kaplan-Meier法进行生存分析.结果:根据实体瘤的疗效评定标准(Response Evaluation Criteria in Solid Tumors,RECIST)全部可评价疗效.其中完全缓解(complete response,CR)占0%(0/60),部分缓解(partial response,PR)占3.33%(2/60),疾病稳定(stable disease,SD)占38.33%(23/60),疾病进展(progressive disease,PD)占58.33%(35/60).客观缓解率(CR+PR)为3.33%,疾病控制率(CR+PR+SD)为38.33%(23/60).中位无进展生存期为3.76 mo.甲胎蛋白(a-f e t o p r o t e i n,A F P)阳性胃癌患者的疾病控制以及生存受益优于AFP阴性患者.高血压、骨髓抑制是影响阿帕替尼治疗的最主要的不良反应.结论:阿帕替尼治疗二线及二线以上治疗失败的晚期胃癌仍有较好的疾病控制及生存获益,不良反应可控制,值得临床上广泛应用.展开更多
文摘BACKGROUND:A regimen of epirubicin,cisplatin,and infused fluorouracil(ECF) improves survival among patients with incurable locally advanced or metastatic gastric adenocarcinoma.We assessed whether the addition of a perioperative regimen of ECF to surgery improves outcomes among patients with potentially curable gastric cancer.METHODS:We randomly assigned patients with resectable adenocarcinoma of the stomach,esophagogastric junction,or lower esophagus to either perioperative chemotherapy and surgery(250 patients) or surgery alone(253 patients) .Chemotherapy consisted of three preoperative and three postoperative cycles of intravenous epirubicin(50 mg per square meter of body-surface area) and cisplatin(60 mg per square meter) on day 1,and a continuous intravenous infusion of fluorouracil(200 mg per square meter per day) for 21 days.The primary end point was overall survival.RESULTS:ECF-related adverse effects were similar to those previously reported among patients with advanced gastric cancer.Rates of postoperative complications were similar in the perioperative-chemotherapy group and the surgery group(46 percent and 45 percent,respectively) ,as were the numbers of deaths within 30 days after surgery.The resected tumors were significantly smaller and less advanced in the perioperative-chemotherapy group.With a median follow-up of four years,149 patients in the perioperative-chemotherapy group and 170 in the surgery group had died.As compared with the surgery group,the perioperative-chemotherapy group had a higher likelihood of overall survival(hazard ratio for death,0.75;95 percent confidence interval,0.60 to 0.93;P = 0.009;five-year survival rate,36 percent vs.23 percent) and of progression-free survival(hazard ratio for progression,0.66;95 percent confidence interval,0.53 to 0.81;P < 0.001) .CONCLUSIONS:In patients with operable gastric or lower esophageal adenocarcinomas,a perioperative regimen of ECF decreased tumor size and stage and significantly improved progression-free and overall survival.
文摘目的:探讨阿帕替尼用于二线及二线以上治疗失败的晚期胃癌患者的临床疗效分析及预后因素研究.方法:研究对象为2014-10/2015-08曾接受过二线及二线以上治疗失败的60例晚期胃癌患者,均经病理确诊.给予阿帕替尼口服850m g/d,直至疾病进展,观察临床疗效及不良反应发生情况.应用Kaplan-Meier法进行生存分析.结果:根据实体瘤的疗效评定标准(Response Evaluation Criteria in Solid Tumors,RECIST)全部可评价疗效.其中完全缓解(complete response,CR)占0%(0/60),部分缓解(partial response,PR)占3.33%(2/60),疾病稳定(stable disease,SD)占38.33%(23/60),疾病进展(progressive disease,PD)占58.33%(35/60).客观缓解率(CR+PR)为3.33%,疾病控制率(CR+PR+SD)为38.33%(23/60).中位无进展生存期为3.76 mo.甲胎蛋白(a-f e t o p r o t e i n,A F P)阳性胃癌患者的疾病控制以及生存受益优于AFP阴性患者.高血压、骨髓抑制是影响阿帕替尼治疗的最主要的不良反应.结论:阿帕替尼治疗二线及二线以上治疗失败的晚期胃癌仍有较好的疾病控制及生存获益,不良反应可控制,值得临床上广泛应用.
