• 川北醫(yī)學(xué)院附屬第二醫(yī)院普外二科(四川綿陽 621000);

目的  總結(jié)潛在可切除胃癌的新輔助化療(neoadjuvant chemotherapy，NAC)的現(xiàn)狀。
方法  通過PubMed，以胃腫瘤、胃癌/癌、新輔助治療/化療及術(shù)前治療/化療為關(guān)鍵詞，檢索近5年的相關(guān)文獻。并檢索2007及2008年ASCO年會的相關(guān)進展?？偨Y(jié)NAC在胃癌中的研究現(xiàn)狀，評價其必要性和可行性，分析病例選擇依據(jù)、緩解預(yù)測因子及存在的問題和發(fā)展方向。
結(jié)果  共檢索隨機對照試驗7個，其中3個為Ⅲ期試驗。已進行的多數(shù)研究顯示，NAC在胃癌的治療中是安全、有效和可行的。但生存取得顯著改善的NAC隨機研究尚少，缺乏嚴格NAC與單獨手術(shù)或圍手術(shù)期化療與輔助化療對比的NAC隨機研究。如何選擇適當?shù)牟±?、有效的NAC方案和治療緩解的預(yù)測，尚需要解決。
結(jié)論  NAC在胃癌的治療中是安全、有效和可行的，但仍需進一步嚴格的前瞻性隨機Ⅲ期試驗證實。新的細胞毒性藥物和分子靶向治療可能是將來進展的實質(zhì)基礎(chǔ)。

引用本文： 肖仕明,吳宸,姜淮蕪. 潛在可切除性胃癌的新輔助化療. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(8): 680-685. doi: 復(fù)制

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  2. 2. 肖仕明， 姜淮蕪， 吳宸， 等. 根治性近端胃切除術(shù)后的兩種重建術(shù)式評價 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(9): 682-685.
  3. 3. Cunningham D, Starling N, Rao S, et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer[J]. N Engl J Med, 2008; 358(1): 36-46.
  4. 4. Foukakis T, Lundell L, Gubanski M, et al. Advances in the treatment of patients with gastric adenocarcinoma[J]. Acta Oncol, 2007; 46(3): 277-285.
  5. 5. Sakamoto J, Paoletti X. Meta-analyses of randomized trials assessing the interest of postoperative adjuvant chemotherapy in gastric cancer[J]. J Clin Oncol (Meeting Abstracts), 2008; 26(15S): 4543.
  6. 6. De Vita F, Giuliani F, Galizia G, et al. Neo-adjuvant and adjuvant chemotherapy of gastric cancer[J]. Ann Oncol, 2007; 18(Suppl 6): vi120-vi123.
  7. 7. Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer[J]. N Engl J Med, 2006; 355(1): 11-20.
  8. 8. Rastogi P, Anderson SJ, Bear HD, et al. Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27[J]. J Clin Oncol, 2008; 26(5): 778-785.
  9. 9. Medical Research Council Oesophageal Cancer Working Gro-up. Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial [J]. Lancet, 2002; 359(9319): 1727-1733.
  10. 10. Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer[J]. N Engl J Med, 2004; 351(17): 1731-1740.
  11. 11. Macdonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction[J]. N Engl J Med, 2001; 345(10): 725-730.
  12. 12. Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer[J]. N Engl J Med, 2008; 359(5): 453-462.
  13. 13. Sakuramoto S, Sasako M, Yamaguchi T, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine[J]. N Engl J Med, 2007; 357(18): 1810-1820.
  14. 14. 季加孚. 胃癌外科的現(xiàn)狀與發(fā)展趨勢 [J]. 中國普外基礎(chǔ)與臨床雜志, 2006; 13(1): 1-3.
  15. 15. 陳志新, 張波. 胃癌綜合治療現(xiàn)狀及展望 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(1): 71-73.
  16. 16. Frei E 3rd. Clinical cancer research: an embattled species[J]. Cancer, 1982; 50(10): 1979-1992.
  17. 17. Wilke H, Preusser P, Fink U, et al. Preoperative chemotherapy in locally advanced and nonresectable gastric cancer: a phase Ⅱ study with etoposide, doxorubicin, and cisplatin[J]. J Clin Oncol, 1989; 7(9): 1318-1326.
  18. 18. Songun I, Keizer HJ, Hermans J, et al. Chemotherapy for operable gastric cancer: results of the Dutch randomised FAMTX trial. The Dutch Gastric Cancer Group (DGCG)[J]. Eur J Cancer, 1999; 35(4): 558-562.
  19. 19. Fujii M, Kosaki G, Tsuchiya S, et al. Randomized trial of preoperative adjuvant chemotherapy using oral 5-FU in operable gastric cancer [A]. Proc Am Soc Clin Oncol, 1999; 18: Abstract 1045.
  20. 20. Kang YK, Choi DW, Im YH, et al. A phase Ⅲ randomized comparison of neoadjuvant chemotherapy followed by surgery versus surgery for locally advanced stomach cancer [A]. Proc Am Soc Clin Oncol, 1996; 15: Abstract 503.
  21. 21. Allum W, Cunningham D, Weeden S, et al. Perioperative chemotherapy in operable gastric and lower oesophageal cancer: A randomised, controlled trial (the MAGIC trial, ISRCTN 93793971) [A]. Proc Am Soc Clin Oncol, 2003; 22: Abstract 998.
  22. 22. Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy in operable gastric and lower oesophageal cancer: final results of a randomised, controlled trial (the MAGIC trial, ISRCTN 93793971) [J]. J Clin Oncol (Meeting Abstracts), 2005; 23(16S): 4001.
  23. 23. Boige V, Pignon J, Saint-Aubert B, et al. Final results of a randomized trial comparing preoperative 5-fluorouracil (F)/cisplatin (P) to surgery alone in adenocarcinoma of stomach and lower esophagus (ASLE): FNLCC ACCORD07-FFCD 9703 trial[J]. J Clin Oncol (Meeting Abstracts), 2007; 25(18S): 4510.
  24. 24. Zhang ZX, Gu XZ, Yin WB, et al. Randomized clinical trial on the combination of preoperative irradiation and surgery in the treatment of adenocarcinoma of gastric cardia (AGC)—report on 370 patients [J]. Int J Radiat Oncol Biol Phys, 1998; 42(5): 929-934.
  25. 25. Stahl M, Walz MK, Stuschke M, et al. Preoperative chemotherapy (CTX) versus preoperative chemoradiotherapy (CRTX) in locally advanced esophagogastric adenocarcinomas: First results of a randomized phase Ⅲ trial[J]. J Clin Oncol (Meeting Abstracts), 2007; 25(18S): 4511.
  26. 26. Nio Y, Koike M, Omori H, et al. A randomized consent design trial of neoadjuvant chemotherapy with tegafur plus uracil (UFT) for gastric cancer—a single institute study[J]. Anticancer Res, 2004; 24(3b): 1879-1887.
  27. 27. Hartgrink HH, van de Velde CJ, Putter H, et al. Neo-adjuvant chemotherapy for operable gastric cancer: long term results of the Dutch randomised FAMTX trial[J]. Eur J Surg Oncol, 2004; 30(6): 643-649.
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  29. 29. Cascinu S, Scartozzi M, Labianca R, et al. High curative resection rate with weekly cisplatin, 5-fluorouracil, epidoxorubicin, 6S-leucovorin, glutathione, and filgastrim in patients with locally advanced, unresectable gastric cancer: a report from the Italian Group for the Study of Digestive Tract Cancer (GISCAD) [J]. Br J Cancer, 2004; 90(8): 1521-1525.
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  31. 31. Sym S, Chang H, Ryu M, et al. A phase Ⅱ study of neoadjuvant chemotherapy with docetaxel, capecitabine and cisplatin (DXP) in patients with advanced unresectable or intra-abdominal metastatic gastric cancer[J]. J Clin Oncol(Meeting Abstracts), 2007; 25(18S): 4640.
  32. 32. Moon H, Ji JF, Wu AW, et al. Oxaliplatin + 5-fluorouracil/leucovorin (FOLFOX7) as neoadjuvant plus adjuvant treatment versus adjuvant alone in locally advanced resectable gastric cancer: BJSA-01 study design and interim results [A/OL]. 2007 Gastrointestinal Cancers Symposium: Abstract 39.
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