吉西他滨或紫杉醇联合奈达铂治疗局部晚期鼻咽癌效果比较

Efficacy comparison between gemcitabine combined with nedaplatin and paclitaxel combined with nedaplatin in treatment of locally advanced nasopharyngeal carcinoma

目的 研究吉西他滨或紫杉醇联合奈达铂一线治疗局部晚期鼻咽癌的效果.方法 选择2012年5月至2014年8月确诊为局部晚期鼻咽癌的患者40例,采用随机数字表法分为对照组和观察组,观察组患者接受吉西他滨联合奈达铂化疗,对照组患者接受紫杉醇联合奈达铂化疗.比较两组患者的化疗效果、不良反应及肿瘤标志物水平.结果观察组患者的化疗有效率高于对照组[65%（13/20）比30%（6/20）,χ^2=4.912,P〈0.05].两组消化道反应、骨髓抑制、肝损伤、肾损伤发生率差异均无统计学意义（均P〉0.05）.化疗前,对照组血清鳞状细胞癌相关抗原（SCCAg）、细胞角蛋白19片段21-1（CYFRA21-1）水平分别为（2.30±0.31）ng/L和（18.27±2.19）μg/L,观察组分别为（2.34±0.27）ng/L和（18.48±2.25）μg/L,两组间差异均无统计学意义（均P〉0.05）;化疗后,对照组SCCAg、CYFRA21-1水平分别为（1.92±0.22）ng/L和（13.72±1.74）μg/L,观察组分别为（1.20±0.15）ng/L和（8.49±0.91）μg/L,两组间差异均有统计学意义（均P=0.000）.结论 吉西他滨联合奈达铂化疗方案能够提高局部晚期鼻咽癌治疗效果,降低肿瘤标志物含量,且不会增加不良反应,是局部晚期鼻咽癌理想的化疗方案.

Objective To investigate the effect of gemcitabine, paclitaxel combined with nedaplatin in treatment of locally advanced nasopharyngeal carcinoma. Methods 40 patients diagnosed as locally advanced nasopharyngeal carcinoma from May 2012 to August 2014 were randomly divided into observation group and control group. Patients in the observation group received gemcitabine plus nedaplatin chemotherapy, while those in the control group received paclitaxel plus nedaplatin chemotherapy. Then chemotherapy effect, adverse reactions, survival time and tumor marker contents were compared. Results The effective rate of the observation group was 65 % （13/20）, which was higher than that （30 %, 6/20） of the control group （χ^2 = 4.912, P〈 0.05）, however, there were no statistically differences in gastrointestinal reactions, bone marrow suppression, liver damage, kidney damage between groups （P〉 0.05）. Before chemotherapy, the SCCAg and CYFRA21-1 content of the control group were （2.30 ±0.31） ng/L and （18.27±2.19）μg/L, and the observation group were （2.34±0.27） ng/L and （18.48±2.25）μg/L, and there was no significant difference between the groups （P〉0.05）. After chemotherapy, the SCCAg and CYFRA21-1 content of the control group were （1.92±0.22） ng/L and （13.72±1.74） μg/L, and the observation group were （1.20 ±0.15） ng/L and （8.49 ±0.91） μg/L （P= 0.000）. Conclusion Gemcitabine combined with nedaplatin chemotherapy can improve the chemotherapy effect and reduce tumor marker content, without increasing more adverse reactions, which is an ideal chemotherapy regimen for advanced nasopharyngeal carcinoma.