| BackgroundGallbladder carcinoma is one of the common malignancies in the digestive system.Due to the hidden symptoms of patients with early gallbladder cancer,most of the cases are diagnosed in the middle and late stages of the tumor.The carcinoma is prone to occur local invasion and distant metastasis,and it is the most aggressive biliary tumors.The overall prognosis of patients with gallbladder cancer is poor,with a 5-year survival rate which is less than 5%.Progressive gallbladder cancer refers to the invasion of the tumor beyond the muscular layer of the gallbladder wall or the occurrence of distant metastasis,including stage II,III and IV in the TNM stages.In these stages,the surgical removal rate is lower,and the prognosis is worse than the early stage.With the advancement of anesthesia techniques and surgical techniques,it is possible for patients with advanced gallbladder cancer to achieve R0 resection.In recent years,the number of patients with advanced gallbladder carcinoma undergoing radical mastectomy has continually increased year by year,which has effectively improved the prognosis of patients with advanced gallbladder carcinoma.Gallbladder cancer can easily undergo local recurrence and metastasis after surgery,andchemotherapy is one of the important means to control the recurrence of postoperative tumors reported by some scholars.At present,there is no uniform standard for postoperative chemotherapy for gallbladder cancer,and it is urgent for the majority of clinicians to work together to explore a safe and effective chemotherapy regimen.PurposeTo analyze the efficacy and safety of gemcitabine combined with tegafur chemotherapy after radical resection in patients with advanced gallbladder cancer.To provide reference and basis for clinicians to formulate individualized treatment plan.MethodsBetween June 2007 and June 2012,a total of 135 patients with advanced gallbladder carcinoma were diagnosed with histopathology and treated with radical R0 resection at the First Affiliated Hospital of Zhengzhou University.To obtain the required clinical data,all patients were followed up by telephone or hospital.The begin of follow-up was the first day after surgery.The end of follow-up was June2017 or the death of the patients.To analyze the clinical effect and toxic reaction of gemcitabine combined with Tegafur Gimeracil and Oteracil Potassium Capsule chemotherapy after radical R0 resection in patients with advanced gallbladder carcinoma.All 135 patients were divided into three groups according to the different therapeutic regimens.Operation groups(Radical resection or Extended radical resection of gallbladder carcinoma)with 47 cases,chemotherapy A group(Tegafur Gimeracil and Oteracil Potassium Capsule combined with Gemcitabine chemotherapy after radical resection or extended radical resection of gallbladder carcinoma)with 52 cases,and chemotherapy B group(5-Fluorouracil combined with Oxaliplatin chemotherapy after radical resection or extended radical resection of gallbladder carcinoma)with 36 cases.Collecting the data of all patients with the median survival time and the 1,3,5-year survival rate after operation,describing the survival curves of three groups,and comparing the clinical efficacy and incidence of major toxic reaction of the two chemotherapy regimens.ResultsThere were no significant differences in the general data of three groups(sex,age,tumor size,CA199,CA125,TNM stages,with or without cholecystolithiasis,operation methods,operation complication).In the operation group,the median survival time and the 1,3,5-year survival rate were 19 months,87.2%,19.1%,4.3%.In the chemotherapy A group(total 50 patients successfully accomplished chemotherapy),the median survival time and the 1,3,5-year survival rate were 27 months,90.0 %,40.0 %,18.0 %.In the chemotherapy B group(total 32 patients successfully accomplished chemotherapy),the median survival time and the 1,3,5-year survival rate were 25 months,81.3%,40.6%,21.9%.There were significant differences in the median survival time(19months vs.27 month or 25 months)between the operation group and chemotherapy A group or chemotherapy B group.There were no significant differences in the 1-year survival rate(87.2%、90.0%、81.3%)between the three groups.There were significant differences in the 3-year survival rate(19.1 % vs.40.0% or 40.6 %)and 5-year survival rate(4.3 % vs.18.0% or 21.9%)between the operation group and the chemotherapy A group or the chemotherapy B group.The chemotherapy A group and chemotherapy B group had no differences in the median survival time and 1,3,5-year survival rate after operation.A total of 6 patients(2 patients of chemotherapy group A and 4 patients of chemotherapy group B)could not tolerate toxic side effects and interrupted chemotherapy.There were significant differences in the incidence of the whole toxic reaction(55.8 % vs88.9 %)and the incidence of grade III and above of the toxic reaction between chemotherapy A group(5.8 %,3/52)and chemotherapy B group(27.8%,10/36).Conclusions1.Chemotherapy can obviously improve the prognosis of patients with advancedgallbladder carcinoma after radical resection.2.The chemotherapy regimen of Tegafur,Gimeracil and Oteracil Potassium Capsule combined with Gemcitabine not only can effectively improve the prognosis of patients with advanced gallbladder cancer after radical resection,but also has a higher safety and is more easily accepted by patients. |
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