王一淙,才保加

胃癌是全球高发的消化系统恶性肿瘤之一，死亡率居第三[1]。针对中晚期胃癌的标准治疗方案通常为以氟尿嘧啶类和铂类为基础的双药化疗。然而，传统化疗疗效有限，患者生存改善仍不理想。近年来，新型紫杉类药物白蛋白结合型紫杉醇（nab-紫杉醇）显示出提高疗效的潜力。在一项多中心Ⅲ期试验中，nab-紫杉醇+S-1相比SOX显著延长了进展-无生存期（PFS）（中位9.03 vs 5.07个月，HR≈0.59，P=0.03）且可控毒性[1]。P-SOX方案（nab-紫杉醇+奥沙利铂+S-1）作为强化的三药化疗组合被提出，用于进一步提高肿瘤缩小率和生存收益。在一项队列研究中，nab-紫杉醇+S-1一线治疗中晚期胃癌的疗效和安全性优于SOX（ORR较高，无进展生存期延长）[2]。本综述旨在比较P-SOX方案与传统SOX方案用于胃癌（主要为局部进展期或转移性胃癌）治疗的近期疗效和远期疗效。文献资料显示，安全性方面，一项回顾性研究在D2术后胃癌患者中比较了nab-紫杉醇+S-1 vs SOX，发现3年疾病无复发生存率AS组78.0%vs SOX 70.7%，不良事件可控，虽≥3级血液学毒性略有差异但整体耐受性好[4]。在患有腹膜转移的胃癌患者中，AS方案相比SOX显示中位总生存及无进展生存均较长（OS 14.13 vs 11.17个月，PFS 10.30 vs 6.70个月）且毒性差异不显著[5]。总的来说，P-SOX方案在提高胃癌患者近期肿瘤缓解率方面具有优势，并有改善生存的趋势，毒性增加但可耐受。未来有必要通过前瞻性随机对照试验进一步验证P-SOX方案的生存获益，并优化患者选择，从而为胃癌治疗提供更有效的方案。

胃癌；P-SOX方案；SOX方案；疗效；安全性

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