化疗联合贝伐珠单抗治疗结直肠癌肝转移的临床观察

Clinical Observation of Chemotherapy Combined with Bevacizumab in the Treatment of Colorectal Cancer Liver Metastases

目的：观察化疗联合贝伐珠单抗治疗结直肠癌肝转移（CLMs）的疗效及肝脏毒性反应。方法：126例结直肠癌肝转移瘤患者按随机数字表法分为化疗组（54例）和联合组（72例）。化疗组患者使用FOLFOXIRI化疗方案：伊立替康165 mg/m^2＋奥沙利铂85 mg/m^2＋亚叶酸钙200 mg/m^2＋氟尿嘧啶2 g;联合组患者在FOLFOXIRI方案基础上于化疗前1天加用5 mg/kg贝伐珠单抗。2周为1个疗程,两组患者均治疗12个疗程。比较两组患者的病理学应答、生存率及化疗引起的肝脏毒性反应。结果：联合组患者病理学完全应答率、肿瘤消退等级（TRG）4-5、患者比例、肿瘤坏死率≥50%患者比例显著高于化疗组,差异均有统计学意义（P〈0.01）;联合组患者TRG 4-5、TRG 1-3生存率显著高于化疗组,差异有统计学意义（P〈0.05）;联合组患者肝脏实质坏死发生率显著低于化疗组,差异有统计学意义（P〈0.05）。结论：化疗联合贝伐珠单抗治疗能够改善患者病理学应答和CLMs的坏死程度,且不会增加肝脏毒性反应。

OBJECTIVE：To observe therapeutic efficacy and liver toxicity of chemotherapy combined with bevacizumab in the treatment of colorectal cancer liver metastases（CLMs）. METHODS：126 CLMs patients were selected and randomly divided into chemotherapy group（54 cases）and combination group（72 cases）. Chemotherapy group received FOLFOXIRI regimen：irinotecan165 mg/m^2＋ oxaliplatin 85 mg/m^2＋ calcium folinate 200 mg/m^2＋ fluorouracil 2 g. Combination group was additionally given bevacizumab 5 mg/kg one day before chemotherapy on the basis of FOLFOXIRI regimen. A treatment course of 2 groups lasted for 2weeks,and both received 12 courses of treatment. The pathological response,survival rate and toxic reactions caused by chemotherapy were compared between 2 groups. RESULTS：Pathological complete response proportion,tumor remission rating（TRG）,the proportion of patients with tumor necrosis rate ≥50% in combination group were significantly higher than chemotherapy group,with statistical significance（P〈0.01）. The proportion of TRG4-5,TRG 1-3 progression-free survival in combination group were significantly higher than chemotherapy group,with statistical significance（P〈0.05）. The incidence of liver parenchymal necrosis in combination group was significantlg higher than chemotherapy group,there was statistical significance（P〉0.05）. CONCLUSIONS：Chemotherapy combined with bevacizumab can improve pathological response and the incidence of CLMs necrosis and doesn＇t increase liver toxicity.