载药微球支气管动脉化疗栓塞联合全身化疗和单纯全身化疗治疗不可切除肺鳞癌的疗效差异

Differences in efficacy between drug-eluting beads transbronchial arterial chemoembolization combined with systemic chemotherapy and systemic chemotherapy alone for unresectable lung squamous cell carcinoma

目的探讨载药微球支气管动脉化疗栓塞(DEB-BACE)联合全身化疗和单纯全身化疗治疗不可切除肺鳞癌的疗效差异。方法回顾性分析盐城市第三人民医院2017年1月至2019年1月接受全身化疗的60例不可切除肺鳞癌患者,根据患者意愿分为单纯化疗组(A组)和联合治疗组(B组)。A组采用吉西他滨联合顺铂化疗方案。B组前半程应用DEB-BACE,后半程(BACE术后3 d开始)应用全身化疗,前半程和后半程化疗剂量均为A组药物剂量的1/2。对比两组近期疗效、不良反应发生率、外周血T淋巴细胞亚群水平、血清血管内皮生长因子(VEGF)水平和生存时间。结果治疗2个周期后,A组和B组总有效率分别为50.0%(15/30)和76.7%(23/30),差异有统计学意义(P<0.05)。A组恶心呕吐(63.3%比20.0%)、食欲下降(76.7%比43.3%)、脱发(86.7%比40.0%)和骨髓抑制(40.0%比10.0%)的发生率均高于B组(均P<0.05)。治疗2个周期后,两组CD^3+、CD^4+和CD^4+/CD^8+水平均高于治疗前(A组分别为47.7%±6.6%比52.3%±7.7%,31.5%±4.9%比34.7%±5.8%,1.05±0.24比1.18±0.32;B组分别为49.2%±7.0%比62.0%±14.0%,29.2%±5.5%比42.2%±7.3%,1.07±0.26比1.39±0.42),均P<0.05。CD8+水平均低于治疗前A组为30.4%±5.4%比24.5%±4.8%,B组为29.5%±4.1%比21.1%±4.5%,均P<0.05。A组CD^3+、CD^4+和CD^4+/CD^8+水平均低于B组(均P<0.05),而CD8+水平高于B组(P<0.05)。治疗2个周期后,两组VEGF水平低于治疗前[A组:(423±85)比(352±64)ng/L;B组:(404±114)比(296±66)ng/L],P<0.05;A组VEGF水平高于B组(P<0.05)。A组和B组1年生存率分别为54.9%和77.9%,2年生存率分别为17.2%和41.7%(Log rankχ^2=4.750,P=0.029)。结论DEB-BACE联合全身化疗治疗不可切除肺鳞癌的疗效优于单纯全身化疗,可减少不良反应,改善免疫功能,延长生存时间,值得临床推广应用。

Objective To investigate the differences in efficacy between drug-eluting beads transbronchial arterial chemoembolization(DEB-BACE)combined with systemic chemotherapy and systemic chemotherapy alone for unresectable lung squamous cell carcinoma.Methods Totally 60 cases of unresectable lung squamous cell carcinoma undergoing systemic chemotherapy in Yancheng Third People Hospital were retrospectively selected as the research object.According to patients′wishes,they were divided into chemotherapy-only group(group A)and combined treatment group(group B).Group A received gemcitabine combined with cisplatin chemotherapy.DEB-BACE was applied in the first half,and systemic chemotherapy was administered in the second half(starting 3 d after BACE).The first half and the second half of the chemotherapy dose were 1/2 of the drug dose in the chemotherapy alone group.The short-term efficacy,incidence of toxic side effects,peripheral blood T lymphocyte subsets,serum vascular endothelial growth factor(VEGF)levels,and survival time were compared between the two groups.Results After 2 cycles of treatment,the total effective rates of group A and group B were 50.0%(15/30)and 76.7%(23/30)(P<0.05),the incidence of nausea and vomiting(63.3%vs 20.0%),decreased appetite(76.7%vs 43.3%),hair loss(86.7%vs 40.0%),and bone marrow suppression(40.0%vs 10.0%)in group A were higher than in group B(all P<0.05).After 2 cycles of treatment,the levels of CD^3+,CD^4+and CD^4+/CD^8+in the two groups were higher than before treatment(group A:47.7%±6.6%vs 52.3%±7.7%,31.5%±4.9%vs 34.7%±5.8%,1.05±0.24 vs 1.18±0.32;group B:49.2%±7.0%vs 62.0%±14.0%,29.2%±5.5%vs 42.2%±7.3%,1.07±0.26 vs 1.39±0.42;all P<0.05),while the level of CD8+was lower than before treatment(group A:30.4%±5.4%vs 24.5%±4.8%;group B:29.5%±4.1%vs 21.1%±4.5%;all P<0.05).The CD^3+,CD^4+,and CD^4+/CD^8+levels in group A were lower than those in group B(P<0.05),while CD8+level was higher than in group B(P<0.05).After 2 cycles of treatment,the VEGF levels in the two groups were lower than before treatment(group A:(423±85)vs(352±64)ng/L;group B:(404±114)vs(296±66)ng/L;P<0.05),and the VEGF level in group A was higher than that in group B(P<0.05).The 1-year survival rates of groups A and B were 54.9%and 77.9%,and the 2-year survival rates were 17.2%and 41.7%(Log rankχ^2=4.750,P=0.029).Conclusion DEB-BACE combined with systemic chemotherapy is superior to systemic chemotherapy in the treatment of unresectable lung squamous cell carcinoma.It can reduce toxic and side effects,improve immune function and prolong survival time,which is worthy of clinical application.