目的:观察阿帕替尼联合化疗用于一线及以上化疗失败后晚期胃癌的临床疗效及生存分析。方法:按照制定的患者纳入和排除标准收集自2016 年3 月至2017 年4 月郑州大学第一附属医院肿瘤内科72 例胃癌晚期患者，随机分为单纯化疗组、阿帕替尼单药组、阿帕替尼联合化疗组，分析比较三组患者的临床疗效及预后影响因素分析。结果:单纯化疗组、阿帕替尼单药组、阿帕替尼联合化疗组的疾病控制率（DCR）分别为48.3%、61.1%和72.0%（P>0.05），客观缓解率（ORR）分别为13.8%、16.7%和28.0%（P>0.05）。3~4 级不良反应发生率分别为17.1%、16.8%和24.0%（P>0.05）。以单纯化疗组为对照，其他两组患者中位无进展生存期（mPFS）分别为93、117（P>0.05）、160 d（P=0.001）。经单因素和多因素COX分析发现，有无腹水（P=0.041）、TNM分期（P=0.036）及治疗方案（P=0.001）是mPFS的独立影响因素。结论:阿帕替尼联合化疗用于一线及以上化疗失败的晚期胃癌的缓解率较高，不良反应可控，安全性较好，有可观的生存获益。

Objective: To observe the clinical efficacy of apatinib combined with chemotherapy for advanced gastric cancer as secondline and above treatment, and to analyze the survival of patients. Methods: Seventy-two patients with advanced gastric cancer that treated at Department of Oncology, the First Affiliated Hospital of Zhengzhou University from March 2016 to April 2017 were included in this study according to the inclusion and exclusion criteria; patients were randomly divided into chemotherapy group, apatinib group,apatinib combined with chemotherapy group. And the clinical efficacy and the survival of patients were investigated. Results: For chemotherapy group, apatinib group, apatinib combined with chemotherapy group, the disease control rate (DCR) and objective response rate (ORR) were 48.3%, 61.1%,72.0% (P>0.05) and 13.8%, 16.7%, 28.0%(P>0.05), respectively; and the incidence rate of adverse reaction at grade three-four was 17.1%, 16.8% and 24.0% (P>0.05), respectively. Compared with the chemotherapy group (93 d), the median progress-free survival (mPFS) time in the apatinib group and apatinib combined with chemotherapy group was 117 d (P=0.128) and 160 d (P=0.001). Furthermore, univariate and multivariate analyses showed that TNM staging (P=0.036), ascites (P=0.041) and treatment regimen (P=0.001) were the independent factors affecting PFS. Conclusion: As the second-line or above treatment in advanced gastric cancer, compared with single chemotherapy and single apatinib group, apatinib combined with chemotherapy displays more satisfactory achievement in remission rate, accompanied by controllable adverse reactions and considerable survival benefit.

国家自然科学基金资助项目(No. 81472605)