吡柔比星动脉灌注化疗治疗非转移性四肢骨肉瘤的疗效及其对T淋巴细胞亚群的影响

Efficacy of pirarubicin-based arterial infusion chemotherapy on non-metastatic limb osteosarcoma and its influence on T lymphocyte

目的观察吡柔比星动脉灌注化疗治疗非转移性四肢骨肉瘤的疗效及其对T淋巴细胞亚群的影响。方法选取68例非转移性四肢骨肉瘤患者,随机分为观察组和对照组,每组34例。术前仅观察组行含吡柔比星动脉灌注化疗,两组均应用保肢手术-术后静脉滴注化疗的治疗方案。分别比较两组患者的近远期临床疗效和T淋巴细胞亚群变化水平。结果观察组和对照组的治疗有效率分别为91.18%和70.59%,观察组治疗有效率明显高于对照组(P<0.05);观察组术后肢体功能评定优良率为76.47%,高于对照组的52.94%,且Enneking评分也明显高于对照组(P<0.05);但两组患者不良反应发生率、平均生存时间和第1年生存率比较差异均无统计学意义(P>0.05),观察组第2年生存率高于对照组(P<0.05),局部复发率、转移率低于对照组(P<0.05)。术后两组患者CD4+、CD4+/CD8+细胞显著增加,CD8+细胞明显降低(P<0.05),而且观察组患者改善程度明显优于对照组(P<0.05)。结论含吡柔比星动脉灌注化疗可显著提高非转移性四肢骨肉瘤的近期临床疗效,提高患者生存率,并提高T淋巴细胞亚群水平。

Objective To investigate the efficacy of pirarubicin-based arterial infusion chemotherapy on non-metastatic limb osteosarcoma and its influence on T lymphocyte. Methods A total of 68 cases of non-metastatic limb osteosarcoma were randomly divided into observation group or the control group,with 34 in each group. Treatment protocols included limb sparing surgery and intravenous chemotherapy for both group,with additional pirarubicin-based arterial infusion chemotherapy before treatment only for the observation group. The short-and long-term clinical effects and level of T lymphocyte were compared between the two groups. Results The effective rate and the excellent and good rate of observation group were significantly higher than those of the control group（ 91. 18% vs. 70. 59%,76. 47% vs. 52. 94%,respectively,P 〈0. 05）,and so was Enneking score（ P 〈0. 05）. No significant difference in adverse reaction rate,average survival time,or 1-year survival rate was observed between two groups（ P 〈0. 05）,but 2-year survival rate was significantly higher（ P 〈0. 05）,and local recurrence and metastasis rate was significantly lower in observation group than in control group（ P 〈0. 05）. After surgery,both the level of CD4＋T cell and the ratio of CD4＋/ CD8＋increased,whereas the level of CD8＋T cell decreased in both groups,with the changes more apparent in the observation group（ P 〈0. 05）. Conclusion Pirarubicin-based arterial infusion chemotherapy could improve the clinical efficacy of non-metastatic osteosarcoma,enhance the survival rate of patients,and increase the level of T lymphocyte.