曲妥珠单抗、吉西他滨、紫杉醇联合疗法对转移性乳腺癌患者血清肿瘤标志物和免疫功能的影响

Effects of Combined Therapy of Trastuzumab,Gemcitabine and Paclitaxel on Serum Tumor Markers and Immune Function in Patients with Metastatic Breast Cancer

目的 探讨曲妥珠单抗、吉西他滨、紫杉醇联合疗法对转移性乳腺癌的临床疗效。方法 选取80例既往因其他因素未接受曲妥珠单抗治疗(已确诊为内脏转移,不包含脑转移)的晚期HER2阳性转移性乳腺癌患者作为此次研究对象,利用随机数字表法分为2组,各40例。对照组采用吉西他滨联合曲妥珠单抗治疗,研究组在此基础上联用紫杉醇。对2组患者血清肿瘤标志物、免疫功能、不良反应及临床疗效进行观察对比。结果 2组患者血清中CEA、CA125、CA153和TPS指标治疗前比较,均无统计学差异(P>0.05),治疗后较治疗前均明显降低(P<0.05),且研究组较对照组下降更为显著(P<0.05)。对照组和研究组CD3^+、CD4^+、CD4^+/CD8^+及NK治疗前比较无统计学差异(P>0.05),治疗后上述指标组内比较均显著下降(P<0.05),且研究组CD3^+、CD4^+/CD8^+及NK较对照组降低更明显,差异有统计学意义(P<0.05)。研究组患者治疗后的客观缓解率和临床受益率均显著高于对照组,统计学差异明显(P<0.05)。治疗期间,2组患者发生骨髓抑制、腹泻、肝损伤、肾功能异常等不良反应发生率比较,无统计学差异(P>0.05)。结论 曲妥珠单抗联合吉西他滨和紫杉醇治疗乳腺癌可有效减少肿瘤标志物分泌,抑制肿瘤生长,提高机体免疫功能,疗效显著,是一种安全有效的新辅助化疗方案,临床可以推广。

Objective To explore and analyze the clinical efficacy of combination of trastuzumab and gemcitabine in the treatment of metastatic breast cancer. Methods 80 cases with advanced HER2-positive metastatic breast cancer patients who underwent treatment were previously treated for trastuzumab (other than those already diagnosed with visceral metastasis and no brain metastases) due to other factors in our hospital were selected as the research object (January 2014~2017 June).They were divided into two groups by random number table,40 cases in each group.The control group was treated with gemcitabine and trastuzumab,and the research group combined with paclitaxel on the basis of this study.The serum tumor markers,immune functions,adverse reactions and clinical effects were observed and compared in the two groups. Results Two groups of patients with serum CEA,CA125,CA153 and TPS index before treatment were statistically no significant difference ( P >0.05),after treatment were significantly lower than before treatment ( P <0.05),and the study group than in the control group decreased significantly ( P <0.05);the control group and the research group,CD3^+ CD4^+,CD4^+/CD8^+ and NK before treatment,no significant difference ( P >0.05),the above indicators were compared after treatment were significantly decreased ( P <0.05),and study group CD3^+,CD4^+/CD8^+ and NK decreased more significant than the control group,the difference was statistically significant ( P < 0.05 );patients in study group after the objective response rate and clinical benefit rate were significantly higher than that of the control group,statistically significant difference ( P <0.05);during treatment,two groups of patients with myelosuppression,diarrhea,liver damage,abnormal renal function and the incidence of adverse reactions were no significant statistical difference ( P < 0.05). Conclusion Trastuzumab combined with gemcitabine and paclitaxel in the treatment of breast cancer can effectively reduce the secretion of tumor markers,inhibit tumor growth and improve immune function.It is a safe and effective neoadjuvant chemotherapy program,which can be popularized in clinical practice.