阿帕替尼联合多西他赛及顺铂二线治疗晚期食管癌的疗效

Efficacy of apatinib combined with docetaxel and cisplatin as a second-line chemotherapy in treatment of advanced esophageal cancer

目的:对比阿帕替尼单药与阿帕替尼联合多西他赛及顺铂(DP方案)在治疗晚期食管癌中的疗效及安全性。方法:选取泰州市人民医院2015年1月-2020年12月收治的60例一线化疗失败的食管癌患者。按随机数字表法分为阿帕替尼组(A组)和阿帕替尼联合DP方案组(B组),每组30例。A组给予阿帕替尼单药化疗,B组给予阿帕替尼联合DP方案化疗。比较两组患者二线治疗前后肿瘤标志物癌胚抗原(carcinoembryonlic antigen,CEA)、糖类抗原199(carbohydrate antigen 199,CA199)、糖类抗原72-4(carbohydrate antigen,CA72-4)的变化;计算两组患者有效率和疾病控制率;分析两组患者二线治疗后免疫细胞含量的变化;记录化疗过程中两组患者药品不良反应(adverse drug reactions,ADRs)发生情况,并对两组患者的生活质量进行评价。结果:治疗后,与A组比较,B组患者肿瘤标志物CEA、CA199、CA72-4水平均显著降低(P<0.05),有效率和疾病控制率均显著升高(P<0.05);外周血T淋巴细胞亚群CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)显著升高,CD8^(+)显著降低(P<0.05)。化疗过程中,B组患者骨髓抑制、胃肠道反应发生率显著高于A组(P<0.05),两组手足综合征、蛋白尿、高血压发生率无显著差异(P>0.05)。治疗后B组欧洲癌症研究与治疗组织(European Organization for Research and Treatment of Cancer,EORTC)生命质量测定量表(quality of life questionnaire,EORTC QLQ-C30)评分显著低于A组(P<0.05)。结论:阿帕替尼联合DP方案作为食管癌一线治疗失败后的二线化疗方案,能够抑制肿瘤进展,提高患者自身免疫功能,改善患者生活质量。

Objective:To compare the efficacy and safety of apatinib alone and apatinib combined with docetaxel and cisplatin(DP regimen)in treatment of advanced esophageal cancer(EC).Methods:Sixty advanced EC patients who failed in the first-line chemotherapy in the Taizhou People’s Hospital from January 2015 to December 2020 were selected as study subjects.The patients were randomly divided into the apatinib group(group A)and the apatinib combined with DP regimen group(group B),each consisting of 30 patients.The patients in group A were treated with simple apatinib chemotherapy,while the patients in group B had apatinib combined with DP regimen chemotherapy.The changes in tumor markers such as carcinoembryonic antigen(CEA),carbohydrate antigen 199(CA199)and carbohydrate antigen 72-4(CA72-4)were compared between the 2 groups before and after second-line chemotherapy.The effective rate and disease control rate(DCR)of the patients in the 2 groups were calculated,the changes of immune cell percentage in the patients of the 2 groups were analyzed,the incidence of adverse drug reactions(ADRs)in the 2 groups were recorded,and the life quality of the patients in the 2 groups was evaluated in course of treatment.Results:After treatment,the levels of CEA,CA199 and CA72-4 in group B decreased significantly,compared with those of the patients in group A(P<0.05),and effective rate and DCR in group B significantly elevated as compared with those of the patients in group A(P<0.05).The peripheral levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+)T cells in the patients of group B significantly increased,while the level of CD8+T cells significantly decreased(P<0.05).In the course of chemotherapy,the rates of myeloid suppression and gastrointestinal reaction in the patients of group B were significantly higher than those in group A(P<0.05),and there were no statistical differences in the rates of hand-foot syndrome,proteinuria and hypertension,when comparisons were made between the 2 groups(P>0.05).After treatment,the scores of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire(EORTC QLQ-C30)in the patients of group B were significantly lower than those of group A(P<0.05).Conclusion:Apatinib combined with DP regimen as a second-line chemotherapy regimen in treatment of advanced EC patients who failed in the first-line chemotherapy could inhibit tumor progression,enhance autoimmune function,and improve life quality of the patients.