替吉奥联合奥沙利铂治疗晚期胃癌的有效性

Efficacy of S-1 combined with oxaliplatin in the treatment of advanced gastric cancer

目的:探讨替吉奥联合奥沙利铂治疗晚期胃癌的有效性。方法:选取2014年8月至2017年8月江苏省海安市人民医院收治的80例晚期胃癌患者为研究对象,将所选患者按随机数字表法分为对照组和观察组,每组40例。对照组患者采用奥沙利铂治疗,观察组患者采用奥沙利铂联合替吉奥治疗,对比两组患者的临床疗效,治疗前后的免疫功能、生活质量以及血浆白介素6(IL-6)、白介素10(IL-10)和肿瘤坏死因子α(TNF-α)水平,并记录两组患者治疗期间的药品不良反应(ADRs)。结果:观察组患者的治疗有效率明显高于对照组(92.5%vs 75.0%,P=0.034)。两组患者化疗后的CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平均较化疗前显著降低(P<0.05),但化疗后观察组CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平高于对照组(P<0.05)。两组患者治疗后的欧洲癌症研究与治疗组织开发的生命质量测定量表(EORTC QLQ-C30)各维度评分均较治疗前升高(P<0.05),治疗后观察组患者的EORTC QLQ-C30各维度评分显著高于对照组患者(P<0.05)。治疗前两组患者的IL-6、IL-10及TNF-α水平比较无显著差异(P>0.05),治疗后两组患者的IL-6、IL-10及TNF-α水平均高于治疗前,且观察组显著高于对照组(P<0.05)。观察组的ADRs发生率高于对照组(20.0%vs 10.0%),但两组比较无显著差异(P=0.363)。对照组中位随访时间为13.57个月,中位生存时间为8.32个月(95%CI:5.56~17.24个月),2年生存率为15.0%;观察组中位随访时间为15.84个月,中位生存时间为12.62个月(95%CI:6.43~23.62个月),2年生存率为32.5%。经log-rank检验,两组生存时间差异具有统计学意义(P<0.001)。多因素Cox比例风险模型分析表明,CD4^(+)/CD8^(+)、TNM分期、治疗方案为影响晚期胃癌患者生存时间的独立相关因素(P<0.05)。结论:采用奥沙利铂联合替吉奥治疗晚期胃癌患者临床疗效良好,毒副作用小,对患者的免疫功能影响较小,还可以有效降低患者的血清炎症反应,改善患者的生活质量,延长生存时间。

Objective:To explore the efficacy of S-1 combined with oxaliplatin in the treatment of advanced gastric cancer.Methods:Eighty patients with advanced gastric cancer admitted in Haian People’s Hospital of Jiangsu Province from August 2014 to August 2017 were selected as subjects,and they were randomly divided into the control group and the observation group,each consisting of 40 patients.The patients in the control group were treated with oxaliplatin,while the patients in the observation group were treated with oxaliplatin combined with S-1.Then,clinical efficacy,changes in immune function before and after therapy,quality of life,the levels of plasma interleukin 6(IL-6),interleukin 10(IL-10)and tumor necrosis factor alpha(TNF-α)were compared between the 2 groups.Adverse drug reactions(ADRs)of the patients in the 2 groups were recorded during treatment.Results:The clinical efficacy rate of the observation group was significantly higher than that of the control group(92.5%vs 75.0%,P=0.034).The levels of CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)in the patients of the 2 groups after chemotherapy were decreased significantly as compared with those before chemotherapy(P<0.05).However,the levels of CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)in the patients of the observation group after chemotherapy were higher than those in the control group(P<0.05).Various scores of life quality questionnaire formulated by the Europe Organization for Research and Treatment of Cancer(EORTC QLQ-C30)in the 2 groups after treatment were all higher than those before treatment(P<0.05),and the scores of EORTC QLQ-C30 after treatment in the patients of the observation group were significantly higher than those in the patients of the control group(P<0.05).Before treatment,there were no significant differences in the levels of IL-6,IL-10 and TNF-αwhen comparisons were made between the 2 groups(P>0.05).However,following treatment,the levels of IL-6,IL-10 and TNF-αin the patients of the 2 groups were all higher than those before treatment,with the levels of the observation group being significantly higher than those of the control group(P<0.05).The incidence of ADRs in the observation group was higher than that of the control group(20.0%vs 10.0%),but no significant differences could be noted,when comparisons were made between the 2 groups(P=0.363).In the control group,the median follow-up time was 13.57 months,the median survival time was 8.32 months(95%CI:5.56-17.24 months),and the two-year survival rate was 15.0%.The median follow-up time and the median survival time of the observation group were respectively 15.84 and 12.62 months(95%CI:6.43-23.62 months),and the two-year survival rate was 32.5%.Log-rank test indicated that there was statistical significance in survival time when comparisons were made between the 2 groups(P<0.001).Analysis by multivariate Cox proportional hazard model showed that CD4^(+)/CD8^(+),TNM staging and treatment regimen were independent factors influencing the survival time of the patients with advanced gastric cancer(P<0.05).Conclusion:The combined use of oxaliplatin and S-1 in the treatment of the patients with advanced gastric cancer could produce good clinical efficacy,with low toxicity and side effects,as well as low effect on the immune function.Furthermore,it could effectively reduce serum inflammatory response,improve life quality and prolong survival time of the patients.