郭士源, 王治宽, 戴广海. CAPOX与CAPOX序贯多西他赛方案应用于Ⅲ期胃癌辅助治疗的疗效对比[J]. 解放军医学院学报, 2024, 45(7): 718-723. DOI: 10.12435/j.issn.2095-5227.2024.098
引用本文: 郭士源, 王治宽, 戴广海. CAPOX与CAPOX序贯多西他赛方案应用于Ⅲ期胃癌辅助治疗的疗效对比[J]. 解放军医学院学报, 2024, 45(7): 718-723. DOI: 10.12435/j.issn.2095-5227.2024.098
GUO Shiyuan, WANG Zhikuan, DAI Guanghai. CAPOX versus CAPOX sequential docetaxel regimen in treatment of adjuvant treatment of stage Ⅲ gastric cancer[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2024, 45(7): 718-723. DOI: 10.12435/j.issn.2095-5227.2024.098
Citation: GUO Shiyuan, WANG Zhikuan, DAI Guanghai. CAPOX versus CAPOX sequential docetaxel regimen in treatment of adjuvant treatment of stage Ⅲ gastric cancer[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2024, 45(7): 718-723. DOI: 10.12435/j.issn.2095-5227.2024.098

CAPOX与CAPOX序贯多西他赛方案应用于Ⅲ期胃癌辅助治疗的疗效对比

CAPOX versus CAPOX sequential docetaxel regimen in treatment of adjuvant treatment of stage Ⅲ gastric cancer

  • 摘要:
    背景 Ⅲ期胃癌患者术后复发率较高,术后辅助化疗可以使患者生存获益,但部分患者无法耐受多周期化疗。在乳腺癌的辅助治疗模式中,不同药物的序贯化疗可减少化疗的不良反应且不影响疗效,但该治疗模式在胃癌治疗中尚未得到验证。
    目的 比较Ⅲ期胃癌患者术后接受8周期卡培他滨联合奥沙利铂(CAPOX)方案辅助化疗与4周期CAPOX序贯4周期多西他赛(CAPOX→D)方案的疗效。
    方法 回顾性分析2009年1月1日— 2020年12月30日在解放军总医院行术后辅助化疗的141例Ⅲ期胃癌患者的临床数据。比较CAPOX与CAPOX→D方案化疗患者的无病生存期(disease-free survival,DFS)、总生存期(overall survival,OS)和化疗不良反应,并进行不同预后因素的单因素和多因素分析。
    结果 CAPOX方案组95例,其中男性75例,女性20例,≥60岁36例,<60岁59例;CAPOX→D方案组46例,其中男性39例,女性7例,≥60岁16例,<60岁30例,两组间性别和年龄的差异无统计学意义(P>0.05)。CAPOX组中位DFS为23.2(95% CI:15.6 ~ 30.8)个月,CAPOX→D组中位DFS为23.0(95% CI:11.7 ~ 34.3)个月,差异无统计学意义(P=0.074)。CAPOX组中位OS为38.2(95% CI:27.8 ~ 48.6)个月,CAPOX→D组中位OS为46.2(95% CI:30.6 ~ 61.8)个月,差异有统计学意义(P=0.026)。预后因素分析显示,女性较男性有更高的进展风险(HR=1.649,95% CI:1.066 ~ 2.552,P=0.025);女性(HR=1.645,95% CI:1.094 ~ 2.607,P=0.030)、肿瘤位于胃体区(HR=1.751,95% CI:1.110 ~ 2.761,P=0.016)及幽门区(相较于贲门区;HR=1.889,95% CI:1.129 ~ 2.960,P=0.005)死亡风险较高,CAPOX→D方案辅助化疗的死亡风险较CAPOX方案下降(HR=0.663,95% CI:0.445 ~ 0.989,P=0.044)。CAPOX组的骨髓抑制(76.8% vs 41.3%,P=0.005)、消化道反应(84.2% vs 60.7%,P=0.010)和周围神经毒性(51.6% vs 32.6%,P=0.030)不良反应发生率较CAPOX→D组更高。
    结论 相比CAPOX方案,Ⅲ期胃癌患者术后选择CAPOX→D方案辅助化疗生存获益更大,安全性更高。

     

    Abstract:
    Background The postoperative recurrence rate of stage Ⅲ gastric cancer is high. Postoperative adjuvant chemotherapy can improve survival, but some individuals cannot tolerate multiple cycles of chemotherapy. The breast cancer adjuvant therapy models show that different drugs of sequential chemotherapy can reduce the adverse reaction of chemotherapy and does not affect curative effect, however, this treatment approach has not yet been validated for gastric cancer.
    Objective To compare the efficacy of postoperative adjuvant chemotherapy with an 8-cycle CAPOX regimen versus adjuvant chemotherapy with a 4-cycle CAPOX sequential 4-cycle docetaxel (CAPOX→D) regimen in patients with stage Ⅲ gastric cancer.
    Methods Clinical data about 141 patients with stage Ⅲ gastric cancer who underwent postoperative adjuvant chemotherapy in Chinese PLA General Hospital from January 1, 2009 to December 30, 2020 were retrospectively collected. Patients in the CAPOX regimen group completed 8 cycles of adjuvant chemotherapy, and patients in the CAPOX→D regimen group completed 4 cycles of CAPOX chemotherapy followed by 4 cycles of docetaxel adjuvant chemotherapy. The disease-free survival (DFS), overall survival (OS) and adverse effects of chemotherapy in patients treated with two different regimens of chemotherapy, CAPOX and CAPOX→D, were compared, and univariate and multivariate analyses were performed to analyze different prognostic factors.
    Results  The CAPOX group consisted of 95 cases, including 75 males and 20 females, with 36 cases aged ≥60 years and 59 cases aged <60 years. The CAPOX→D group consisted of 46 cases, including 39 males and 7 females, with 16 cases aged ≥60 years and 30 cases aged <60 years. There was no statistically significant difference in gender and age between the two groups (P>0.05). The median DFS of the CAPOX group was 23.2 months (95% CI: 15.6-30.8 months), and it was 23.0 months in the CAPOX→D group (95% CI: 11.7-34.3 months), with no statistically significant difference (P=0.074). The median OS was 38.2 months (95% CI: 27.8-48.6 months) in the CAPOX group and 46.2 months (95% CI: 30.6-61.8 months) in the CAPOX→D group, and the difference was statistically significant (P=0.026). Cox regression results demonstrateed, compared to male, female had a higher risk of disease of progression (HR=1.649, 95% CI: 1.066-2.552, P=0.025); female (HR=1.645, 95% CI: 1,094-2.607, P=0.030), tumor located in the gastric body (HR=1.751, 95% CI: 1.110-2.761, P=0.016) or pyloric area (HR=1.889, 95% CI: 1.129-2.960, P=0.005) showed higher mortality risk. Compared with CAPOX regimen, CAPOX→D regimen decreased the risk of death (HR=0.663, 95% CI: 0.445-0.989, P=0.044). The incidences of adverse reactions in CAPOX group, including bone marrow suppression (41.3% vs 76.8%, P=0.005), digestive tract reaction (60.7% vs 84.2%, P=0.010) and peripheral nerve toxicity (51.6% vs 32.6%, P=0.030), were higher than those of CAPOX→D group.
    Conclusion Postoperative choice of adjuvant chemotherapy with CAPOX→D regimen is safe and beneficial to patients with stage Ⅲ gastric cancer.

     

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