进展期胃癌化疗规范及计划方案的优化选择(北大肿瘤).ppt

进展期胃癌化疗规范及方案 的优化选择 ;*;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%;中国胃癌发病的特点;2007.v.1;Randomized Phase III Study In First Line For AGC ;胃癌规范治疗： NCCN指南作用;NCCN 2010.v.2更新，引发新的讨论;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;;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. ;;;;;如术前未应用(m)ECF，根治术后应该采用何种辅助治疗方式及治疗方案?; 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 pooled HR for OS was 0·78 (95 CI 0·71 to 0·85) in favour of chemotherapy. Subgroup analysis showed that the advantage of chemotherapy was not influenced by depth of tumour infiltration status of lymph node metastasis type of lymphadenectomy geographical distribution of patients route of drug administration;根治性胃癌 切除术(D2);总生存期;Stage II ;Stage IIIA ;Stage IIIB ;II、IIIA期根治术后患者, S-1单药辅助化疗显著改善总生存期和无复发生存 IIIB期根治术后无统计学差异（ 患者样本量不足?） (每组不足90例) 目前国内外的相关研究 中国实际状况 ;;INT0116与ACTS-GC试验结果对比;胃癌患者根治术后复发转移模式分析-----北京肿瘤医院消化内科单中心分析;结 果; 胃癌根治术后复发转移情况对比;韩国 III期试验 (ARTIST): 可切除胃癌术后辅助XP与XP + 放疗的III 期试验;可切除胃癌围手术期化疗---MAGIC trial;3 cycles FP Q4W;;可切除胃癌新辅助治疗： 英国ECX方案研究;初始无法切除胃癌术前治疗：希罗达＋多西他赛＋顺铂(DXP) II期研究;胃癌的整体治疗模式;转移性/复发性胃癌化疗方案的优