目的 观察多西他赛三药及两药联合对胃癌根治术后辅助化学疗法（化疗）的疗效比较及不良反应。 方法 回顾性分析解放军总医院2006年1月－2011年12月42 例胃癌根治术后患者的临床资料，其中有22例、20例患者分别接受以多西他赛为基础的三药、两药联合辅助化疗。三药联合：多西他赛注射液+铂类+氟尿嘧啶/卡培他滨片/替吉奥；两药联合：多西他赛注射液+氟尿嘧啶/卡培他滨片/替加氟或多西他赛注射液+铂类；主要观察终点：无疾病生存期（DFS），次要观察终点：预后因素分析、复发转移情况、不良反应及亚组分析。 结果 两组中位DFS分别为9.530、7.170个月（P=0.646）；性别、年龄、肿瘤浸润深度、脉管癌栓、淋巴结清扫范围是患者早期复发转移的不良预后因素，三药联合组肝转移率高于两药联合组（P=0.008）；主要不良反应为恶心、呕吐、白细胞减少、腹泻、脱发、血小板减少等，多为1～2级，可耐受，三药联合组较两药联合组易出现不良反应（P=0.011），以恶心、呕吐为主。 结论 胃癌根治术后以多西他赛为基础的辅助化疗三药、两药联合对患者疗效及预后无明显差异，且两种辅助疗法不良反应基本可耐受。
ObjectiveTo review and summarize the clinical data and survival information of patients with cholangiocarcinoma treated by surgery, and to explore the clinical and pathological features of cholangiocarcinoma, and the relationship between intraoperative and postoperative characteristics and prognosis. MethodsWe retrospectively analyzed the clinical data of 678 cholangiocarcinoma patients after operation in the PLA General Hospital from January 2004 to December 2010, including the follow-up results of 397 cases. Only 293 patients with surgical resection of cholangiocarcinoma and non-surgical reasons for death were analyzed using Cox proportional hazards model. All indicators were analyzed by univariate and multivariate analysis. ResultsThe median follow-up time was 55.9 months. As of the end of follow-up, there were 158 cases of recurrence (53.9%) and 223 cases of death (76.1%). The median overall survival time was 21.2 months, and 1-year, 3-year and 5-year survival rates were 71.7%, 38.2% and 10.6%, respectively. Tumor differentiation, TNM stage, surgical margin, intraoperative blood transfusion, tumor location, alkaline phosphatase levels in blood and recurrence were independent risk factors for overall survival time. ConclusionLow degree of tumor differentiation, advanced TNM stage, cancer invasion on the surgical margin, intraoperative blood transfusion, tumor located outside the liver, alkaline phosphatase levels in blood higher than normal, and cholangiocarcinoma tumor recurrence are risk factors for overall survival rate in patients with cholangiocarcinoma.