卡培他滨联合奥沙利铂在结直肠的黏液腺癌及印戒细胞癌中的临床疗效研究

Clinical efficacy of capecitabine combined witih oxaliplatin in the treatment of colorectal mucinous adenocarcinoma and signet ring cell carcinoma

目的观察卡培他滨联合奥沙利铂化疗方案在结直肠的黏液腺癌和印戒细胞癌中的临床疗效差异。方法 100例术后病理类型为黏液腺癌及印戒细胞癌的患者,按照癌症类型分为A组(黏液腺癌)50例和B组(印戒细胞癌)50例。2组患者均用卡培他滨联合奥沙利铂化疗方案治疗,第1~14天口服卡培他滨1000 mg·m^(-2),早晚2次,第1天静脉滴注130 mg·m^(-2)的奥沙利铂3 h,3周为1个疗程,观察2组患者治疗前后血清转化生长因子α(TGF-α)、胰岛素生长因子Ⅱ(IGF-Ⅱ)、干扰素γ(IFN-γ)、白细胞介素(IL)-2、IL-4及IL-10水平变化情况,观察2组患者的近期疗效和治疗后不良反应的发生情况,并对患者进行5年的病情随访,观察患者5年内的生存率情况。结果治疗后,A组血清TGF-α和IGF-Ⅱ显著低于B组(P<0.05)。A组血清IFN-γ和IL-2水平显著高于B组,IL-4和IL-10水平显著低于B组(P<0.05)。A组总有效率为92.00%(46/50),显著高于B组的70.00%(35/50,P<0.05);5年内的生存率高于B组(P<0.05)。A组不良反应的发生率(8%,4/50)明显低于B组(22%,11/50,P<0.05)。结论结直肠的黏液腺癌和印戒细胞癌在病理特点以及预后情况上有较大的差异,临床上的治疗应将两者分开,以达到最好的治疗效果,减轻患者的痛苦,改善预后。

Objective To investigate the differences of curative effect of capecitabine combined with and oxaliplatin in the treatment of colorectal mucinous adenocarcinoma and signet ring cell carcinoma.Methods One hundred patients with mucinous adenocarcinoma or signet ring cell carcinoma were divided into A group（ colorectal mucinous adenocarcinoma） and B group（ signet ring cell carcinoma） according to cancer type,50 cases in each group.Two groups of patients were treated with capecitabine and oxaliplatin（ 1-14 d,twice taking capecitabine1000 mg·m^-2,1 d and intravenous drip of 130 mg·m L^-1of oxaliplatin for 3 h,3 weeks for a course of treatment）.The changes of serum,transforming growth factor α（ TGF-α）,insulin like growth factor Ⅱ（ IGF-Ⅱ）,interferon-γ（ IFN-γ）,interleukin（ IL）-2,IL-4 and IL-10 were observed before and after treatment,and the incidence of adverse reactions in two groups were observed,the patients were followed up for five years.Results After treatment,the serum TGF-α andIGF-Ⅱ in A group were lower than those in B group,the serum levels of IFN-γ and IL-2 in A group were higher than those in B group,the serum IL-4 and IL-10 levels were lower than those of B group,with statistically significant difference（ P〈0.05）.Total effective rate of A group（ 92.00 %,46 /50） was significantly higher than that of B group（ 70.00 %,35 /50）.The survival rate was higher than that of B group in five years.The incidence of adverse reactions in A group（ 8 %,4 /50） was significantly lower than that in B group（ 22 %,11 /50,P〈0.05）.Conclusion There are great differences in the pathological characteristics and prognosis of colorectal mucinous adenocarcinoma and signet ring cell carcinoma.The clinical treatment should be separated from the two diseases,so as to achieve the best therapeutic effect,reduce the patient＇s pain and improve the prognosis.