肺抑瘤合剂对中、晚期肺鳞状细胞癌预后的影响

Effect of Feiyiliu Mixture on Prognosis of Patients with Middle and Advanced Squamous Cell Carcinoma of Lung

目的:评价肺抑瘤合剂辅助化疗和免疫支持对Ⅲb,Ⅳ期肺鳞状细胞癌(SQCC)患者无进展生存期(PFS),生存率的影响及对外周血肿瘤标志物和细胞因子的干预效果。方法:将132例患者随机按数字表法分为对照组和观察组各66例,均给予盐酸吉西他滨+顺铂的GP方案,替代方案为紫杉醇+顺铂,并给予注射用胸腺肽。观察组同期口服肺抑瘤合剂,对照组同期口服肺抑瘤合剂模拟药。两组患者均连续治疗4个周期。随访记录PFS和12个月生存率,进行治疗前后欧洲生命质量协作组癌症核心量表(EORTC QLQ-C30)评价;检测治疗前后CD3^+,CD4^+,CD8^+,CD4^+/CD8^+水平,检测治疗前后细胞角蛋白19片段21-1(CYFRA21-1),鳞状细胞癌抗原(SCC),糖抗原125(CA125),血管内皮生长因子(VEGF),基质金属蛋白酶-2(MMP-2)和MMP-9;进行治疗前后实体瘤大小的评价。结果:观察组实体瘤疗效临床缓解率为(35/66)53.03%,高于对照组的(23/66)34.85%(χ^2=4.286,P<0.05);观察组PFS为9.8个月(95%CI,4.58~22.37),长于对照组的5.7个月(95%CI,4.69~20.41)(P<0.05);观察组12个月的生存率为(30/36)45.45%,高于对照组的(18/48)27.27%(χ^2=4.714,P<0.05);观察组躯体功能、社会功能和整体生活质量评分均高于对照组(P<0.01),疲乏、恶心呕吐、食欲丧失、便秘、腹泻评分均低于对照组(P<0.01);观察组CD3^+,CD4^+水平和CD4^+/CD8^+均高于对照组(P<0.05),CD8^+低于对照组(P<0.05);观察组CYFRA21-1,SCC,CA125,VEGF,MMP-2和MMP-9水平均低于对照组(P<0.01)。结论:采用肺抑瘤合剂配合化疗和免疫支持治疗Ⅲb,Ⅳ期SQCC患者可延长患者PFS,提高生存率,能稳定免疫功能,提高生活质量,并能抑制CYFRA21-1等肿瘤标志物和VEGF等细胞因子表达,起到改善预后的效果,值得进一步研究和使用。

Objective:To discuss the effect of Feiyiliu mixture as an adjuvant method for chemotherapy and immune support on progression-free survival(PFS)and survival rate of patients withⅢb andⅣstage squamous cell carcinoma of lung(SQCC),and to investigate its intervention effect on tumor markers and cytokines in peripheral blood.Method:One hundred and thirty-two patients were randomly divided into control group(66 cases)and observation group(66 cases)by random number table.Patients in control group received programme of gemcitabine hydrochloride combined with cisplatin(alternative paclitaxel combined with cisplatin)and they also got thymopolypeptides for injection,while the patients in observation group received Feiyiliu mixture,with a treatment course of 4 cycles in both groups.PFS and 12 months’survival rate were recorded during followup.Scores of European quality of life collaboration cancer core scale(EORTC QLQ-C30)were graded before and after treatment.Levels of CD3^+,CD4^+,CD8^+,CD4^+/CD8^+,cytokeratin 19 fragment 21-1(CYFRA21-1),squamous cell carcinoma antigen(SCC),carbohydrate antigen 125(CA125),vascular endothelial growth factor(VEGF),matrix metalloproteinase-2(MMP-2)and MMP-9 were detected,and size of solid tumor was evaluated before and after treatment.Result:Clinical remission rate of solid tumor was(35/66)53.03%in observation group,higher than(23/66)34.85%in control group(χ^2=4.286,P<0.05).PFS in observation group was9.8 months(95%CI,4.58-22.37),more than 5.7 months in control group(95%CI,4.69-20.41)(P<0.05).12 months’survival rate was 45.45%(30/36)in observation group,more than 27.27%(18/48)in control group(χ^2=4.714,P<0.05).Scores of physical function,social function and overall quality of life in observation group were higher than those in control group(P<0.01),and scores of fatigue,nausea and vomiting,shortness of breath,loss of appetite,constipation and diarrhea were lower than those in control group(P<0.01).Levels of CD3^+,CD4^+and CD4^+/CD8^+in observation group were higher than those in control group(P<0.05),while levels of CD8^+,CYFRA21-1,SCC,CA125,VEGF,MMP-2 and MMP-9 were lower than those in control group(P<0.01).Conclusion:Adjuvant Feiyiliu mixture combined with chemotherapy and immune support can prolong PFS,improve survival rate,stabilize immune function,improve quality of life,inhibit the expression of cytokines such as CYFRA21-1 and vascular endothelial growth factor,and improve prognosis for patients withⅢb andⅣstage SQCC.Therefore,it is worth further study and use.