晚期胃食管胃结合部腺癌二线治疗方案疗效及安全性的回顾性研究

  目的  探讨晚期胃/食管胃结合部（gastric/gastroesophageal junction，G/GEJ）腺癌适宜的二线治疗方案。  方法  回顾性分析2019年1月至2021年3月于河南省肿瘤医院以紫杉醇单药和紫杉醇联合抗血管或程序性细胞死亡受体-1（programmed cell death protein 1，PD-1）单抗作为二线治疗的晚期G/GEJ腺癌的临床资料。  结果  收集101例患者，中位随访时间为10.4个月，中位总生存期（overall survival，OS）为9.5个月。紫杉醇单药治疗组（43例）、紫杉类联合抗血管组（22例）和紫杉类联合免疫组（36例）客观缓解率（overall response rate，ORR）分别为9.3%、 27.3% 和30.6%，疾病控制率（disease control rate，DCR）分别为60.5%、86.4% 和80.6%，中位无进展生存期（progression-free survival，PFS）分别为2.7个月、4.3个月和3.9个月，中位OS分别为7.0个月、12.0个月和11.0个月，差异均具有统计学意义（均P<0.05）。三组不良反应均可控，无新型不良事件发生，联合抗血管组高血压发生率为40.9%（9/22），联合PD-1单抗组免疫相关不良反应发生率为19.4%（7/36），与其他两组相比差异均具有统计学意义（均P<0.05）；多因素分析显示美国东部肿瘤协作组（ECOG）评分、腹膜转移是患者OS的独立影响因素（P<0.05）。  结论  紫杉类联合抗血管或PD-1单抗治疗可有效延长患者PFS及OS，临床疗效显著且安全性高，是晚期胃癌二线治疗可选择的方案。 

Efficacy and safety of second-line treatment regimens for advanced gastric/esophagogastric junction adenocarcinoma: a retrospective study

  Objective  To explore appropriate second-line treatment regimens for advanced gastric/gastroesophageal junction (G/GEJ) adenocarcinoma.   Methods  We retrospectively analyzed the clinical data of patients with advanced G/GEJ adenocarcinoma treated with paclitaxel monotherapy and paclitaxel in combination with anti-vascular or programmed cell death receptor 1 (PD-1) monoclonal antibody as second-line therapy at Henan Cancer Hospital from January 2019 to March 2021.   Results  The clinical data of 101 patients were collected with a median follow-up time of 10.4 months and a median overall survival (OS) of 9.5 months. In the paclitaxel monotherapy (43 cases), paclitaxel combined with anti-vascular (22 cases), and paclitaxel combined with immune (36 cases) groups, the objective response rates (ORR) were 9.3%, 27.3%, and 30.6%, respectively; the disease control rates (DCR) were 60.5%, 86.4%, and 80.6%, respectively; the median progression-free survival (PFS) was 2.7 months, 4.3 months, and 3.9 months, respectively; and the median OS was 7.0 months, 12.0 months, and 11.0 months, respectively, which were statistically significant (P<0.05). Adverse reactions in all three groups were controllable, and no novel adverse events occurred. The incidence of hypertension in the combined anti-vascular group was 40.9% (9/22) and that of immune-related adverse reactions in the combined PD-1 monoclonal antibody group was 19.4% (7/36), both of which were statistically significant compared with those in the other two groups (P < 0.05). A multifactorial analysis showed that the Eastern Cooperative Oncology Group (ECOG) score and peritoneal metastasis were independent influencing factors for patients’ OS (P< 0.05).   Conclusions  Paclitaxel combined with anti-vascular or PD-1 monoclonal antibody can effectively and safely prolong the PFS and OS of patients and is a second-line treatment option for advanced G/GEJ adenocarcinoma.