目的 探讨并比较三药方案DOS(多西紫杉醇+替吉奥+奥沙利铂)与SOX两药方案(奥沙利铂+替吉奥)一线治疗晚期胃癌的疗效和安全性.方法 回顾性分析91例晚期胃癌患者,其中一线治疗接受DOS方案治疗者,设为治疗组,接受SOX方案(奥沙利铂+替吉奥)治疗者,设为观察组.每化疗2个周期进行全面复查,并进行疗效评估;化疗中,化疗后详细记录所有患者出现的不良反应.结果 91例进展期胃癌患者,符合入组条件的患者有60例,其中一线治疗接受DOS方案治疗的有30例,DOS组客观缓解率(RR)为26.7％;一线治疗接受DOS方案治疗者有30例,SOX组RR率为16.7％;DOS组疾病控制率(DCR)为83.3％.SOX组DCR率为73.3％.比较RR及DCR,DOS组均高于SOX组,但差异无统计学意义(P＞ 0.05).两组患者主要不良反应相同,包括血液学毒性(白细胞下降、贫血、血小板下降、肝功能损害)、胃肠道反应(腹泻、呕吐)、和外周神经毒性.其中,ⅠⅡ度肝功能损害DOS组高于SOX组(66.7％比33.3％),差异有统计学意义(P=0.01).Ⅲ度血小板下降SOX组要高于DOS组(16.7％比0％),差异有统计学意义(P=0.021).其它不良反应发生率两组未见明显差异,且主要为ⅠⅡ度,所有患者都未因严重的不良反应而中断化疗.结论 对于晚期胃癌患者的一线治疗,DOS三药方案疗效确切,而且相比SOX组未见不良反应率升高.%Objective The purpose of this study is to investigate the efficacy and safety of DOS (docetaxel + oxaliplatin+ s-1) and SOX regimen (oxaliplatin + s-1) as first-line treatment for patients with advanced gastric cancer. Methods A retrospective analysis on patients with advanced gastric cancer who received first-line treatment in Affiliated Jiangsu Cancer Hospital of Nanjing Medical University was conducted. Patients received DOS regimen were designated as treatment group, and patients received SOX regimen as observation group. All patients underwent a full review every 2 cycles of chemotherapy, then assessments were made, and adverse reactions of all patients occurred during and after the treatment were recorded in detail. Results 91 cases of advanced gastric cancer from January 2013 to January 2016 were analyzed, there were 60 patients who met the criteria of admission (Entry criteria were listed in materials and methods). The objective remission rate (RR) of DOS group was 26. 7％, and in SOX group was 16. 7％. The rate of disease control (DCR) in DOS group was 83. 3％, in SOX group was 73. 3％. The rates of RR and DCR were higher in DOS group than in those in SOX group, but the difference was not statistically significant (P＞ 0. 05). The major adverse effects of chemotherapy were similar in two groups, including hematologic toxicities (leukocyte depletion, anemia, thrombocytopenia, liver dysfunction), gastrointestinal reactions (diarrhea, vomiting), and peripheral neurotoxicity. Among them, Ⅰ ～ Ⅱ degree liver function impairment in DOS group was higher than that in group SOX (66. 7％ to 33. 3％, P ＜0. 05). Degree Ⅲ thrombocytopenia in SOX group was higher than that in DOS group (16. 7％ to 0％, P = 0. 021). The incidence of other adverse reactions, mainly Ⅰ ～ Ⅱ degrees, was not significantly different between two groups. No patient discontinued che motherapy due to serious adverse effects. Conclusion For patients with advanced gastric cancer, DOS regimen is associated with improved curative effect, and lower thrombocytopenia adverse reaction compared with SOX group.
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