醋酸甲羟孕酮片联合奥沙利铂与紫杉醇治疗晚期子宫内膜癌的效果观察

The observation on the effect of medroxyprogesterone acetate tablets combined with oxaliplatin and paclitaxel in the treatment of advanced endometrial cancer

目的:探讨醋酸甲羟孕酮片联合奥沙利铂与紫杉醇治疗晚期子宫内膜癌的临床效果。方法:选择2014年1月至2019年5月山东省齐河县人民医院收治的92例晚期子宫内膜癌患者,依据入组编号奇偶数分为观察组和对照组,每组46例。观察组采用醋酸甲羟孕酮片+奥沙利铂+紫杉醇治疗,对照组采用奥沙利铂+紫杉醇治疗,在治疗周期结束时评价两组疗效及安全性,比较两组治疗前后血清人糖类抗原125(CA125)、血管内皮生长因子(VEGF)、人附睾蛋白(HE4)水平和免疫功能、体能状态及生命质量的变化。结果:观察组总有效率高于对照组[78.26%(36/46)比58.70%(27/46)],差异有统计学意义(χ2=4.079,P<0.05)。观察组治疗后血清CA125、VEGF、HE4水平均低于对照组[(23.27±5.65)kU/L比(30.55±5.71)kU/L、(214.94±23.89)ng/L比(247.62±19.97)ng/L、(26.62±4.23)pmol/L比(32.24±6.68)pmol/L],差异均有统计学意义(P<0.05)。观察组治疗后自然杀伤细胞(NK)、辅助性T淋巴细胞(Th)、细胞毒性T淋巴细胞(Tc)水平均高于对照组(0.287±0.032比0.239±0.027、0.403±0.052比0.333±0.046、0.261±0.029比0.228±0.026),差异均有统计学意义(P<0.05)。观察组治疗后美国东部肿瘤协作组(ECOG)评分低于对照组[(1.37±0.26)分比(1.89±0.34)分],生命质量问卷(QLQ-C30)评分高于对照组[(65.69±7.58)分比(58.35±6.26)分],差异均有统计学意义(P<0.05)。两组不良反应总发生率比较差异无统计学意义(P>0.05)。结论:醋酸甲羟孕酮片联合奥沙利铂与紫杉醇治疗晚期子宫内膜癌安全有效,能降低患者肿瘤标志物水平,并抑制肿瘤血管增生,对免疫功能、体能状况及生命质量均有改善作用。

Objective To explore the clinical effect of medroxyprogesterone acetate tablets combined with oxaliplatin and paclitaxel in the treatment of advanced endometrial cancer.Methods Ninety-two patients with advanced endometrial cancer admitted to Qihe People′s Hospital of Shandong Province from January 2014 to May 2019 were selected.According to the entry number,they were divided into the observation group(the last number was odd,receiving medroxyprogesterone acetate tablets+oxaliplatin+paclitaxel treatment)and the control group(the last number was even,receiving oxaliplatin+paclitaxel treatment).The efficacy and safety of the two groups were evaluated,and the changes of serum human carbohydrate antigen 125(CA125),vascular endothelial growth factor(VEGF),human epididymal protein(HE4)and immune function,physical status and quality of life before and after the treatment were compared and analyzed.Results The total efficacy in the observation group was higher than that in the control group:78.26%(36/46)vs.58.70%(27/46),the difference was statistically significant(P<0.05).After treatment,the levels of serum CA125,VEGF,HE4 in the observation group were lower than those in the control group:(23.27±5.65)kU/L vs.(30.55±5.71)kU/L,(214.94±23.89)ng/L vs.(247.62±19.97)ng/L,(26.62±4.23)pmol/L vs.(32.24±6.68)pmol/L,the differences were statistically significant(P<0.05).After treatment,the levels of serum natural killer cells(NK),helper T lymphoid cells(Th),cytotoxic T lymphoid cells(Tc)in the observation group were higher than those in the control group:(0.287±0.032 vs.0.239±0.027,0.403±0.052 vs.0.333±0.046,0.261±0.029 vs.0.228±0.026,the differences were statistically significant(P<0.05).After treatment,the score of Eastern Cooperative Oncology Group(ECOG)in the observation group were lower than that in the control group:(1.37±0.26)scores vs.(1.89±0.34)scores;the score of Quality of Life Questionnaire(QLQ-C30)in the observation group was higher than that in the control group:(65.69±7.58)scores vs.(58.35±6.26)scores,the differences were statistically significant(P<0.05).The incidence of adverse reactions between the two groups had no significant difference(P>0.05).Conclusions Medroxyprogesterone acetate tablets combined with oxaliplatin and paclitaxel is safe and effective in the treatment of advanced endometrial cancer.This method can reduce the concentration of tumor markers in patients,inhibit tumor angiogenesis,and improve immune function,physical fitness and quality of life.