XELOX方案治疗高、中分化结直肠腺癌与低分化结直肠腺癌的临床疗效差异分析

Difference effect of XELOX regimen on high- moderate differentiated and low differentiated colorectal adenocarcinoma

目的观察低分化结直肠腺癌与高中分化结直肠腺癌用XELOX方案治疗的临床疗效差异。方法 80例结直肠腺癌患者分为对照组40例(低分化结直肠腺癌)和试验组40例(高、中分化结直肠腺癌)。2组患者均使用XELOX方案进行治疗,第1天,静脉滴注奥沙利铂130 mg·m^(-2),滴注3 h,第1~14天,口服卡培他滨1000 mg·m^(-2),早晚各1次,持续用药2周,3周为1个疗程,共治疗3个疗程。观察2组患者治疗前后人转录激活因子5(ATF5)mRNA及B细胞淋巴瘤^(-2)(Bcl^(-2))mRNA相对含量的变化,比较2组患者的临床疗效、药物不良反应发生率,观察2组患者的远期生存率。结果治疗后,试验组ATF5mRNA相对含量为0.43±0.07,Bcl^(-2) mRNA相对含量为0.33±0.04,对照组的ATF5 mRNA相对含量为1.52±0.09,Bcl^(-2) mRNA相对含量为0.78±0.10,差异有统计学意义(P<0.05)。试验组总有效率为87.50%(35/40例),对照组总有效率为60.00%(24/40例,P<0.05)。试验组1,2,3年的生存率分别为87.50%(35/40例),72.50%(29/40例),42.50%(17/40例),对照组1,2,3年的生存率分别为50.00%(20/40例),32.50%(13/40例),7.50%(3/40例),2组差异有统计学意义(P<0.05)。药物不良反应主要表现为中性粒细胞减少、手足反应综合征和恶心呕吐,试验组药物不良反应发生率为15.00%(6/40例),对照组为72.50%(29/40例,P<0.05)。结论由于高、中分化结直肠癌和低分化结直肠癌的病理特点有所不同,临床上对不同分化期的治疗应采取不同的治疗方式,以达到最有效的治疗方式。

Objective To investigate the difference effect of XELOX regimen in the treatment of high and moderate- grade colorectal adenocarcinoma and low- grade colorectal adenocarcinoma. Methods Eighty colorectal cancer patients were divided into two groups according to the differentiation,40 cases in control group was low- grade colorectal adenocarcinoma,and 40 cases in treatment group was high and moderate-grade colorectal adenocarcinoma. Two groups of patients were treated with XELOX regimen（ intravenous infusion of oxaliplatin 130 mg·m-2for 3 h at 1stday,orally given capecitabine 1000 mg·m-2from 1-14 d,twice a day）. Three weeks a course,the treatment was continued for3 courses. The changes of activating transcription factor 5（ ATF5）mRNA and B- cell lymphoma 2（ Bcl-2） mRNA in two groups wereobserved before and after treatment,the clinical efficacy and adverse drug reaction in two groups were observed. The long- term survival rate was observed by following- up for three years. Results After treatment,the levels of ATF5 mRNA,Bcl-2 mRNA in treatment group were 0. 43 ± 0. 07,0. 33 ± 0. 04,had significant difference with 1. 52 ±0. 09,0. 78 ± 0. 10 in control group（ P 〈 0. 05）. The total effective rate in treatment group was 87. 50%（ 35 /40）,had significant difference with 60. 00%（ 24 /40） in control group（ P 〈 0. 05）. The survival rates of three years in treatment group were 87. 50%（ 35 /40）,72. 50%（ 29 /40）,42. 50%（ 17 /40）,had significant difference with 50. 00%（ 20 /40）,32. 50%（ 13 /40）,7. 50%（ 3 /40） in control group（ P 〈 0. 05）. Adverse drug reactions mainly manifested as neutropenia,hand- foot syndrome,nausea and vomiting reaction. The total incidence of adverse reactions in treatment group was 15. 00%（ 6 /40）,had significant difference with 72. 50%（ 29 /40） in control group（ P 〈 0. 05）.Conclusion Due to the pathological characteristics of differentiated colorectal cancer,different treatment methods should be adopted to achieve the most effective treatment.