新辅助化疗对结直肠癌肝转移患者术前的临床效果

Clinical efficacy of preoperative neoadjuvant chemotherapy in hepatic metastasis of colorectal cancer

目的探讨结直肠癌肝转移患者术前采用新辅助化疗的临床效果。方法选取2016年1月至2018年1月间东莞市人民医院收治的60例结直肠癌肝转移患者,按手术方式不同分为观察组和对照组,每组30例。观察组患者采用新辅助化疗联合手术治疗,对照组患者采用单纯手术治疗,比较两组患者的治疗效果。结果两组患者手术时间比较,差异无统计学意义(P>0.05);观察组患者术中出血量较对照组少,术后7d天门冬氨酸氨基转移酶和丙氨酸氨基转移酶较对照组高,差异均有统计学意义(均P<0.05)。观察组患者化疗期间,发生6例恶心呕吐,4例腹泻,4例脱发,2例静脉炎,3例周围神经炎,4例血小板减少。不良反应率较高,但均为Ⅰ~Ⅱ级,给予相应治疗或用药间歇期均可恢复,无1例因无法耐受而停止化疗或死亡。观察组患者治疗有效率和疾病控制率均高于对照组,无疾病进展生存时间长于对照组,差异均有统计学意义(均P<0.05)。观察组患者术后1年和3年的存活率均高于对照组,差异均有统计学意义(均P<0.05)。结论结直肠癌肝转移患者术前采用新辅助化疗的治疗效果优于未化疗患者,能减少患者术中出血量,提高近期疗效,延长生存时间,不良反应较轻,值得临床进一步推广。

Objective To investigate the clinical efficacy of preoperative neoadjuvant chemotherapy in hepatic metastasis of colorectal cancer.Methods Sixty patients with hepatic metastasis from colorectal cancer who received treatment at Dongguan People's Hospital from January 2016 to January 2018 were selected.The patients were randomly divided into an observation group and control group with 30 patients in each group.The observation group was treated with neoadjuvant chemotherapy combined with surgery and the control group was treated with operation alone.The therapeutic efficacy was compared between the two groups.Results There was no significant difference between the two groups(P>0.05).The blood loss was less in the observation than in the control group(P<0.05).Aspartate aminotransferase(AST)and alanine transaminase(ALT)were higher in the observation group than in the control group at 7 d after the operation(all P<0.05).During the chemotherapy,vomiting and nausea occurred in 6 patients,diarrhea occurred in 4 patients,hair loss occurred in 4 patients,phlebitis occurred in 2 patients,peripheralpolyneuritis occurred in 3 patients and thrombocytopenia occurred in 4 patients in the observation group.The incidence of adverse reactions was high and but most of them were gradeⅠ-Ⅱ,which were recovered when given appropriate therapy or medication-taking interval.No patient ceased the treatment of died due to intolerable synonyms.The response rate(RR),disease control rate(DCR)and disease-free survival(PFS)were bet-ter in the observation group than in the control group(all P<0.05).The 1-and 3-year survival rates were higher in the observation group than in the control group(all P<0.05).Conclusion Neoadjuvant chemotherapy is better than non-chemotherapy in patients with liver metastasis of colorectal cancer before operation,and it can reduce the blood loss during the operation,improve the short-term treatment efficacy and prolong the survival time.It is worthy of further promotion and use in the clinical practice.