卡培他滨节拍化疗联合三维适形放疗对晚期老年食管癌患者血清肿瘤标志物、VEGF、CRP及基质金属蛋白酶水平的影响

Effect of capecitabine metronomic chemotherapy and three-dimensional conformal radiotherapy on serum tumor markers,VEGF,CRP,and matrix metalloproteinases in elderly patients with esophageal cancer

目的观察在晚期老年食管癌患者中,应用卡培他滨节拍化疗联合三维适形放疗的方案对其临床疗效、不良反应及对血清肿瘤标志物、血管内皮生长因子(vascular endothelial growth factor,VEGF)、C反应蛋白(c-reactionprotein,CRP)及基质金属蛋白酶水平的影响.方法回顾性分析2011-04/2016-04温州医科大学附属第一医院收治的130例晚期老年食管癌的临床资料,其中60例患者给予PF化疗方案(顺铂75 mg/m^2,d1,5-氟尿嘧啶1 g/m^2,d1-d4;每28 d一个化疗疗程,共二个疗程)联合同期三维适形放疗,将其作为对照组,70例患者给予卡培他滨节拍化疗方案(0.6 g/m^2,bid,早晚餐后口服,每28 d 1个化疗疗程,共2个疗程)联合同期三维适形放疗,将其作为观察组.然后将两组患者的临床疗效、不良反应及血清肿瘤标志物、VEGF、CRP及基质金属蛋白酶水平等指标进行比较.结果经过治疗后,观察组患者的治疗总有效率明显高于对照组(82.86%vs 65.0%),差异有统计学意义(P<0.05);在治疗前,两组患者的CA125、CA19-9、CEA、VEGF、CRP、MMP-2、MMP-9水平无明显差异,无统计学意义(P>0.05);在治疗后,观察组患者的CA125、CA19-9、CEA、VEGF、CRP、MMP-2、MMP-9水平明显低于对照组,差异有统计学意义(P<0.05);观察组患者的白细胞减少、消化道反应、肝功能损害发生率明显低于对照组.结论在晚期老年食管癌患者中应用卡培他滨节拍化疗联合三维适形放疗的治疗方案,能够显著提高临床疗效,有效降低其血清肿瘤标志物、VEGF、CRP及基质金属蛋白酶水平,且具有较高的用药安全性.

AIM To observe the curative effect and side effects of capecitabine metronomic chemotherapy combined with three-dimensional conformal radiotherapy in patients with advanced esophageal cancer and the effect on serum tumor markers, vascular endothelial growth factor （VEGF）, C-reactive protein （CRP）, and matrix metalloproteinases. METHODS The clinical data of 130 elderly patients with esophageal cancer admitted to our hospital from April 2011 to April 2016 were retrospectively analyzed. Among them, 60 patients received the PF chemotherapy regimen （PDD 75 mg/m2, dl, 5-Fu 1 g/m2, dl-d4; one course of chemotherapy for every 28 d, two courses in total） combined with three-dimensional conformal radiotherapy （control group）, and the other 70 patients were given metronomic chemotherapy （0.6 g/m2, bid, oral administration after breakfast and dinner, one course of chemotherapy for every 28 d, two courses in total） combined with three-dimensional conformal radiotherapy （observation group）. Clinical efficacy, adverse reactions, serum tumor markers, VEGF, CRP, matrix metalloproteinases, and other indicators were compared in the two groups of patients. RESULTS The total effective rate was significantly higher in the observation group than in the control group （82.86% vs 65.0%, P 〈 0.05）. Before treatment, there was no significant difference in the levels of CA125, CA19-9, CEA, VEGF, CRP, MMP-2, or MMP-9 between the two groups （P 〉 0.05）. After treatment, the levels of CA125, CA19-9, CEA, VEGF, CRP, MMP-2, and MMP-9 in the observation group were significantly lower than those in the control group （8.05 ± 2.32 vs 9.76± 2.35, 7.06 ±6.61 vs 9.22 ± 8.58, 1.39 ± 0.39 vs 1.89 ± 0.46, 259.25 ± 21.21 vs 352.28± 30.37, 6.25± 0.16 vs 9.08 ±0.22, 65.05 ± 1.71 vs 91.12 ±2.01, 297.06 ± 146.61 vs 492.22 ±158.58, P 〈 0.05）. The incidence rates of leukopenia, digestive tract reactions, and liver dysfunction were significantly lower in the observation group than in the control group （15.71% vs 35.0%, 27.14% vs 51.67%, 18.57% vs 36.67%, P 〈 0.05）. CONCLUSION Capecitabine metronomic chemotherapy in combination with three-dimensional conformal radiotherapy in elderly patients with esophageal cancer can significantly improve clinical efficacy and effectively reduce serum tumor markers, VEGF, CRP, and matrix metalloproteinases with high safety.