胃癌治疗指南解读北京大学沈琳课件.pptVIP

NCCN胃癌治疗指南的解读——内科治疗部分 (2010 V.2);*;上海 (2002-2004): 发病率仍高 : 恶性肿瘤中，男性占第二位，女性占第三位 疾病部位: 胃窦最常见,为 39.88%, 小弯为12.68%; 年度 年龄;AJCC 分期 美国 日本 中国 ⅠA 78% 95% 93.7% ⅠB 58% 86% 80.2% Ⅱ 34% 71% 65.7% ⅢA 20% 59% 44.8% ⅢB 8% 35% 23.1% Ⅳ 7% 17% 10.8% 总计 28% 61.4％ 40%;中国胃癌发病的特点;东方国家胃癌预后好于西方的可能原因;;2010年中国版与2009年相比，主要更新内容;清除幽门螺旋杆菌感染与早期胃癌术后预防复发的关系;R A N D O M I Z E;;;ToGA 试验设计;HER2-positivity rate  Europe (23.6%) Asia (23.5%)  Taiwan 5.9% (n=34)  Australia 32.8%  (n=61) China 22.6%± （n=590）;HER2阳性率与肿瘤部位和类型有关;Primary end point: OS;Secondary end point: PFS;11 3;Secondary end point: tumor response rate;Safety:与对照组比较无明显增加;Safety: cardiac AEs;结 论 和 前 景;;;OS ;phase III Ramdomized 3-armed study of S-1 monotherapy versus S-1/CDDP(SP) versus 5-FU/CDDP(FP) in patients with advanced gastric cancer(AGC) (SC-101 study);;;;Log-rank Test: p = 0.1983 Hazard Ratio: 0.92 (95% CI: 0.80, 1.05) Median Overall Survival: CS: 8.6 months CF: 7.9 months;;Advanced Gastric Cancer S-1 Mono therapy for patients with poor condition;Advanced Gastric Cancer S-1 Monotherapy for elderly patients;;2002.6-2004.8 纳入141 例患者(中位年龄Age: 53.7ys) 化疗方案: Cape 1000mg/m2 Bid d1-14 DDP 20mg/m2 iv d1-5 q3W WHO 评价疗效 CTC v2.0评价不良反应;Meta-analysis of REAL2 and ML17032 trials in advanced oesophago-gastric cancer;Evidence ：卡培他滨 对比 S-1 A randomised multicentre phase II trial of 卡培他滨 vs S-1 as first-line treatment in elderly patients with metastatic or recurrent unresectable gastric cancer.Y. Kang, Br J Cancer. 2008 Aug 19;99(4):584-90. ;;;;2010.v.2 NCCN 指南 ——中国版;可切除胃癌围手术期化疗---MAGIC trial; Patients：3809 pts Methods: 12 RCT from Jan. 1998 to Dec. 2007 4 from Japan, 4 from Italy, 2 from France,1from Spain or Poland T1 was excluded, only D1 or more was included Surgery alone group (1913 pts) vs CT+surgery group (1896 pts);Results: The po