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目的探讨分子标志物切除修复交叉互补基因1(ERCC1)指导晚期胃癌治疗的疗效。方法 93例晚期初治胃癌患者,ERCC1阳性表达组(A组,28例)采用希罗达+紫杉醇(XT方案)化疗,ERCC1阴性表达组(B组,26例)采用希罗达+奥沙利铂(XELOX方案)化疗,未行ER-CC1检测的患者随机选择XT方案(C组,20例)或XELOX方案(D组,19例)化疗,观察指标为总有效率(RR)、无进展生存时间(PFS)、总生存时间(OS)。结果入组93例患者中位随访20个月,4组方案RR分别为A组57.0%、B组54.0%、C组35.0%和D组32.0%,差异无统计学意义。4组方案中位PFS分别为A组7.2个月、B组7.0个月、C组5.0个月和D组4.9个月(P<0.05)。中位OS分别为A组12.8个月、B组12.9个月、C组10.1个月和D组9.5个月(P<0.05)。亚组分析显示,体能状态评分0～1分组、2分组PFS分别为8.1和4.2个月,中位OS分别为15.8个月和7.5个月,体能状态良好者的生存时间长于ERCC1分层治疗的生存时间。结论 ERCC1分子标志物指导下的分层治疗能显著提高晚期胃癌一线治疗疗效,但体能状态仍是影响晚期胃癌患者预后的主要因素。
Objective To investigate the effect of molecular marker resection and repair of cross-complementing gene 1 (ERCC1) in the treatment of advanced gastric cancer. Methods Ninety-three patients with newly diagnosed gastric cancer were enrolled in this study. The patients with ERCC1 positive expression (group A, n = 28) were treated with Xeloda + paclitaxel (XT) chemotherapy and the patients with ERCC1 negative expression (group B, n = 26) Patients in the non-ER-CC1 group were randomized to chemotherapy with platinum (XELOX regimen) and chemotherapy with XT regimen (group C, n = 20) or XELOX regimen (group D, n = 19) Progressive survival time (PFS), total survival time (OS). Results The 93 patients enrolled in the study were followed up for a median of 20 months. The RR of the 4 groups was 57.0% in group A, 54.0% in group B, 35.0% in group C and 32.0% in group D, respectively. There was no significant difference between the two groups. The median PFS in the 4 groups was 7.2 months in group A, 7.0 months in group B, 5.0 months in group C and 4.9 months in group D (P <0.05). The median OS was 12.8 months in group A, 12.9 months in group B, 10.1 months in group C, and 9.5 months in group D (P <0.05). Subgroup analysis showed that the PFS was 8.1 and 4.2 months respectively in the 0 to 1 group and the 2 group, and the median OS was 15.8 months and 7.5 months respectively. The survival time of those with good physical status was longer than that of ERCC1 stratified treatment Survival time. Conclusion The stratified treatment guided by ERCC1 molecular markers can significantly improve the efficacy of first-line treatment of advanced gastric cancer, but the physical status is still the main factor affecting the prognosis of patients with advanced gastric cancer.