NCCN胃癌治疗指南解读(北京大学沈琳)课件.ppt

NCCN胃癌治疗指南的解读——内科治疗部分 (2010 V.2);*;上海 (2002-2004): 发病率仍高 : 恶性肿瘤中，男性占第二位，女性占第三位 疾病部位: 胃窦最常见,为 39.88%, 小弯为12.68%; 年度 年龄;AJCC 分期 美国 日本 中国 ⅠA 78% 95% 93.7% ⅠB 58% 86% 80.2% Ⅱ 34% 71% 65.7% ⅢA 20% 59% 44.8% ⅢB 8% 35% 23.1% Ⅳ 7% 17% 10.8% 总计 28% 61.4％ 40%;中国胃癌发病的特点;东方国家胃癌预后好于西方的可能原因;;2010年中国版与2009年相比，主要更新内容;清除幽门螺旋杆菌感染与早期胃癌术后预防复发的关系;R A N D O M I Z E;;;ToGA 试验设计;HER2-positivity rate  Europe (23.6%) Asia (23.5%)  Taiwan 5.9% (n=34)  Australia 32.8%  (n=61) China 22.6%± （n=590）;HER2阳性率与肿瘤部位和类型有关;Primary end point: OS;Secondary end point: PFS;11 3;Secondary end point: tumor response rate;Safety:与对照组比较无明显增加;Safety: cardiac AEs;结 论 和 前 景;;;OS ;phase III Ramdomized 3-armed study of S-1 monotherapy versus S-1/CDDP(SP) versus 5-FU/CDDP(FP) in patients with advanced gastric cancer(AGC) (SC-101 study);;;;Log-rank Test: p = 0.1983 Hazard Ratio: 0.92 (95% CI: 0.80, 1.05) Median Overall Survival: CS: 8.6 months CF: 7.9 months;;Advanced Gastric Cancer S-1 Mono therapy for patients with poor condition;Advanced Gastric Cancer S-1 Monotherapy for elderly patients;;2002.6-2004.8 纳入141 例患者(中位年龄Age: 53.7ys) 化疗方案: Cape 1000mg/m2 Bid d1-14 DDP 20mg/m2 iv d1-5 q3W WHO 评价疗效 CTC v2.0评价不良反应;Meta-analysis of REAL2 and ML17032 trials in advanced oesophago-gastric cancer;临咒昏腾处蕾挛稗哉尤燕炽泄态睦婚熄继烤烫汀袜窍转哇杯酵晴鸥预藏撮NCCN胃癌治疗指南解读(北京大学沈琳)课件NCCN胃癌治疗指南解读(北京大学沈琳)课件;Evidence ：卡培他滨 对比 S-1 A randomised multicentre phase II trial of 卡培他滨 vs S-1 as first-line treatment in elderly patients with metastatic or recurrent unresectable gastric cancer.Y. Kang, Br J Cancer. 2008 Aug 19;99(4):584-90. ;;;;2010.v.2 NCCN 指南 ——中国版;可切除胃癌围手术期化疗---MAGIC trial; Patients：3809 pts Methods: 12 RCT from Jan. 1998 to Dec. 2007 4 from Japan, 4 from Italy, 2 from France,1from Spain or Poland T1 was excluded, only D1 or more was included Sur