胃癌的辅助治疗新认识.ppt

1胃癌的辅助治疗新认识

(第11届CSCO上海)南昌大学第一附属医院熊建萍2008年08月29日

2流行病学:发病及死亡位次NewCases(rank)Deaths(rank)Unitedstates(2007)121,260(﹟13)11,210(﹟13)Worldwide(2002)2934,000(﹟4)700,000(﹟2)1Jemal,et.al.CACancerJClin2007;57:432Parkin,et.al.CACancerJClin2005;55:75

3流行病学：发病率及部位超势EpidemiologicTrendsWorldwidedeclineinage-adjustedincidencenowparallelspatternpreviouslyobservedinUnitedStatesDiseasenowappearinganatomicallyinamoreproximalpattern

4

5部分国家胃癌发生部位Percentage1.YangH,etal.CancerResTreat2001;33:207–15;2.Inoue,etal.IntJCancer1994;56:494–93;

3.HundalhS,etal.Cancer2000;88:921–2;4.SiewertJ,etal.AnnSurg1998;228:449–61;

5.BonenkampJ,etal.NEnglJMed340;908–1412543

6胃癌5年生存率（中国）时期例数ⅠⅡⅢⅣ总体~197571485.747.827.6023.71976~85261588.762.528.98.035.91986~352090.467.936.78.645.6

7胃癌的临床特点

8重视早期患者的综合治疗

9新辅助化疗的目的

10新辅助化疗的种类

11

12尚缺少Ш期临床研究证据

13新辅助化疗的种类

14CSCn=250Sn=253RCunninghametal,NEnglJMed2006;355:11-20.(MAGIC研究)ECF:E50mg/m2C60mg/m2FU200mg/m2/dciv

15Pre-opECFSurgeryaloneP-valueExtentoftumor(gastriconly)T1/T252%38%0.009T3/T448%62%Nodalstatus(Gastriconly)N0/N184%76%0.01N2/N316%29%

16Pre-opECFN=250SurgeryaloneN=253PMediantimetosurgery99days14daysProceededtosurgery219240R0resection169166R0resectionrate79%(169/219)70%(166/240)0.03R0resectionITT169/250166/253R0rateITT68%66%0.64

17

18

19

20MAGIC:PreoperativeECFvs.Surgeryalone

21

22FFCD9703:研究方案设计

23FFCD9703:入选标准

24FFCD9703:病人特征

25

26

27FFCD9703:5年DFS及OS均有提高

28

29FFCD9703:结论

30新辅助化疗的优点

31重视早期患者的综合治疗

321244316123829191Leeetal2000;2Maruyamaetal1998;

3Landryetal1991;4Macdonaldetal2001Patients(%)D2D254%36%10%D0:D1:D2:LNdissection

33Presenter:Dr.F.DeVitaSurgeryplusELFE(epirubicin,leucovorin,5-fluorouracilandetoposide)vssurgeryaloneinradicall