卡培他滨联合经导管肝动脉化疗栓塞治疗结直肠癌术后肝转移的临床效果

Treatment efficacy of capecitabine combined with transcatheter arterial for hepatic metastases after colorectal carcinoma resection

目的探讨卡培他滨联合经导管肝动脉化疗栓塞（TACE）治疗结直肠癌术后肝转移的临床疗效。方法回顾性分析2012年6月至2014年12月94例结直肠癌术后肝转移患者的临床资料。根据所用治疗方案的不同将患者分为卡培他滨联合TACE组（／7,=48）和单纯TACE对照组（n=46）。记录两组患者化疗药物毒性反应，并对TACE治疗结束后3个月两组患者的近期疗效与肿瘤标志物水平进行比较。随访记录两组患者的生存时间。结果两组TACE治疗次数差异无统计学意义（P〉0．05）。TACE治疗结束后3个月两组疗效差异有统计学意义（Z=2．000，P〈0．05）。联合组化疗有效率（RR）和临床获益率（CBR）均高于对照组[分别为（52．1％比32．0％）、（95．8％比87．0％）]，但差异无统计学意义（均P〉0．05）。联合组治疗结束后3个月[CEA（47．1±10．3）比（35．1±8．4）彬L及CA19-9（78．7±19．6）比（65．3±17．0）kU／L]下降水平显著高于对照组（t1=5．776，t2=7．849，均P〈0．05）。联合组的毒性反应发生率均高于对照组，包括骨髓抑制（39．6％比30．4％）、末梢神经炎（47．9％比34．8％）等，但差异无统计学意义（P〉0．05）。联合组与对照组中位生存期分别为17．3个月、13．5个月；1年生存率分别为72．9％、52．1％（0=4．325，P〈0．05）。两组患者累积生存率差异有统计学意义（x2=4．097，P〈0．05）。结论卡培他滨联合TACE治疗结直肠癌术后肝转移作用协同。联合治疗的近期疗效优于单纯TACE治疗，毒性反应可耐受。

Objective To investigate the treatment efficacy of capecitabine combined with TACE for hepatic metastases after colorectal carcinoma resection. Methods The clinical data of 94 patients who were treated for hepatic metastases after colorectal carcinoma resection from June 2012 to December 2014 were ret- rospectively analyzed. The patients were divided into the combined group （48 patients） who underwent com- bined treatment of transcatheter arterial chemoembolization （TACE） and capecitabine, and the control group （46 patients） who were treated with TACE alone. The drug toxicities induced by chemotherapy in patients of the two groups were noted. The short-term outcomes and serum tumor markers were compared at 3-months af- ter completion of TACE. All the patients were followed up and their overall survival was recorded. Results There was no significant difference in the frequency of TACE between the two groups （ P 〉 0.05 ）. There were significant differences in the short-term outcomes at 3-month after completion of TACE （ Z = 2. 000, P 〈 0.05 ）. The RR （complete response ± partial response ） and CBR （complete response ± partial re- sponse ± stable disease） were higher in the combined group than those in the control group [ （52. 1% vs. 32. 0% ） and （95.8% vs. 87.0% ）, respectively], although the differences were not statistically significant （both P 〉0.05）. There were greater declines in CEA and CA19-9 levels at 3-month after completion of TACE in the combined group than the control group [ （47. 1 ± 10. 3 vs. 35. 1 ±8. 4）μg/L, （78.7 ± 19. 6 vs. 65.3 ± 17. 0） kU/L], but the differences were not significant （ t1 = 5. 776, t2 = 7. 849, both P 〈 0. 05 ）. Toxic reactions were more common in the combined group than those in the control group, which included bone marrow suppression （39. 6% vs. 30. 4% ） and peripheral neuritis （47.9% vs. 34. 8% ）. Again, the differences were not significant （P 〉0.05）. The median survivals were 17.3 months and 13.5 months, and 1-year survival rates were 72. 9% and 52. 1% in the combined group and the control group, respectively （ X^2 = 4. 325, P 〈 0.05 ）. There were significant differences in the survival between the two groups （ X^2 =4. 097, P 〈 0. 05 ）. Conclusions Capecitabine combined with TACE produced better treatment results for hepatic metastases after coloreetal carcinoma resection. The short-term outcomes of the combined treatment was superior to TACE alone, and the treatment toxicities could be tolerated.