晚期非小细胞肺癌患者重组人血管内皮抑制素联合化疗临床观察

Clinical observation of recombinant human endostatin combined with chemotherapy in patients with advanced non-small cell lung cancer

目的非小细胞肺癌(non-small cell lung cancer,NSCLC)患者主要患有原发性支气管肺癌,临床中多采用化疗方式治疗,本研究对晚期NSCLC患者采用不同用药方式治疗的临床疗效进行对比评价。方法选择2015-03-01-2017-10-31济南市长清区人民医院收治的110例晚期NSCLC患者作为研究对象,依照不同用药治疗方式分为观察组和对照组。对照组52例采用顺铂联合吉西他滨治疗,观察组58例采用重组人血管内皮抑制素联合顺铂和吉西他滨治疗,观察2组患者的疗效及不良反应。结果观察组治疗总有效率为58.6%,高于对照组的30.8%,差异有统计学意义,χ^2=5.954,P<0.05。在不良反应方面,观察组和对照组患者血小板计数降低分别为12和20例,差异有统计学意义,χ^2=4.295,P<0.05。观察组和对照组中性粒细胞计数降低分别为30和19例,差异有统计学意义,χ^2=4.934,P<0.05。而在肝肾功能损害方面2组差异无统计学意义,χ^2值分别为0.448和0.450,均P>0.05。与对照组比较,观察组患者化疗后血清胸苷激酶-1(thymidine kinase-1,TK-1)水平为(1.73±0.68)pmol/L,低于对照组的(2.12±0.72)pmol/L,P<0.05;人细胞角蛋白21-1片段(cytokeratins21-1,CYFRA21-1)水平为(7.42±2.86)ng/mL,低于对照组的(9.31±3.11)ng/mL,P<0.05;鳞状上皮细胞癌抗原(squamous cell carcinoma antigen,SCC-Ag)水平为(0.95±0.41)IU/mL,低于对照组的(1.31±0.65)IU/mL,P<0.05;神经元特异性烯醇化酶(neuron specific enolase,NSE)水平为(14.11±5.02)ng/mL,低于对照组的(17.46±5.43)ng/mL,P<0.05。随访2年,观察组患者生存率为32.6%,高于对照组的20.0%,但差异无统计学意义,χ^2=40.442,P>0.05。Log-rank检验结果显示,年龄(P=0.003)、N1(P<0.001)和N2(P<0.001)淋巴结转移、N1(P=0.040)和N2(P=0.025)淋巴结清除数、总的淋巴结清除数(P=0.045)、手术方式(P<0.001)和病理分期(P<0.001)为患者术后的主要影响因素。结论晚期NSCLC患者采用不同用药方式治疗中,重组人血管内皮抑制素联用吉西他滨和顺铂的用药治疗方式疗效明显更好,且安全性相对较高。

OBJECTIVE Patients with non-small cell lung cancer(NSCLC)mainly suffer from primary bronchial lung cancer,and chemotherapy is often used in clinical treatment.In this study,the clinical efficacy of different treatment methods in patients with advanced NSCLC were compared and evaluated.METHODS A total of 110 patients with advanced NSCLC admitted to Changqing District People’s Hospital of Jinan City from March 1,2015 to October 31,2017 were selected as the research objects.Patients in the control group(n=52)were treated with cisplatin combined with gemcitabine,and patients in the observation group(n=58)were treated with recombinant human endostatin combined with cisplatin and gemcitabine.After treatment,the efficacy and side effects of the two groups were observed.RESULTS The total effective rate of the observation group was 58.6%,higher than 30.8%of the control group,the difference was statistically significant,χ^2=5.954,P<0.05.In terms of side effects,the platelet count of the observation group and the control group were 12 and 20 cases respectively,the difference was statistically significant,χ^2=4.295,P<0.05.The neutrophil count of the observation group and the control group were 30 and 19 cases respectively,the difference was statistically significant,χ^2=4.934,P<0.05.However,there was no significant difference between the two groups in terms of liver and kidney function damage(χ^2 values were 0.448 and 0.450,P>0.05).Compared with the control group,the serum level of thymidine kinase-1(TK-1)in the observation group after chemotherapy was(1.73±0.68)pmol/L,which was lower than(2.12±0.72)pmol/L in the control group,P<0.05.The levels of cytokeratins21-1(CYFRA21-1)fragment in the observation group were(7.42±2.86)ng/ml,lower than the control group(9.31±3.11)ng/ml,P<0.05.The level of squamous cell carcinoma antigen(SCC-Ag)in the observation group was(0.95±0.41)IU/ml,which was lower than that of the control group(1.31±0.65)IU/ml,P<0.05.The level of neuron specific enolase(NSE)in the observation group was(14.11±5.02)ng/ml,lower than(17.46±5.43)ng/ml in the control group,P<0.05.After2 years of followed-up,the survival rate of the observation group was 32.6%,higher than 20.0%of the control group,but the difference was not statistically significant,χ^2=40.442,P>0.05.Log rank test results showed that age(P=0.003),N1(P<0.001)and N2(P<0.001)lymph node metastasis,N1(P=0.040)and N2(P=0.025)lymph node dissection,total number of lymph node clearance(P=0.045),operation mode(P<0.001),pathological stage(P<0.001)were the main influencing factors.CONCLUSION Among the patients with advanced NSCLC,recombinant human endostatin combined with gemcitabine and cisplatin has better curative effect and higher safety.