西妥昔单抗联合化疗治疗KRAS基因野生型晚期结直肠癌伴肝转移患者临床效果观察及预后影响因素分析

Clinical effect and prognostic factors analysis of cetuximab combined with chemotherapy in patients with K-Ras wild-type colorectal cancer with liver metastases

目的观察西妥昔单抗联合化疗治疗KRAS基因野生型晚期结直肠癌伴肝转移患者的临床效果,并对预后影响因素进行分析。方法回顾性分析北京大学首钢医院自2010年1月至2019年1月收治的96例KRAS基因野生型晚期结直肠癌伴肝转移患者的临床资料。按照治疗方案不同,将患者分入XELOX组(n=63)和联合组(n=33)。XELOX组采用XELOX化疗方案;联合组在XELOX组基础上加用西妥昔单抗。比较两组的治疗效果、生存情况及不良反应发生率;采用Cox比例风险回归模型分析预后影响因素。结果联合组客观反应率、疾病控制率、皮疹发生率均高于XELOX组,差异有统计学意义(P<0.05)。两组中位无进展生存期差异无统计学意义(P>0.05)。联合组中位总生存期长于XELOX组,差异有统计学意义(P<0.05)。淋巴结转移、肿瘤部位、乳酸脱氢酶是患者中位总生存期的独立预后因素(P<0.05)。结论西妥昔单抗联合化疗治疗KRAS基因野生型晚期结直肠癌伴肝转移临床效果显著,可延长患者总生存期,淋巴结转移、肿瘤部位、乳酸脱氢酶是预后的有效预测因素。

Objective To observe the clinical effect of cetuximab combined with chemotherapy in the treatment of K-Ras wild-type colorectal cancer with liver metastases,and to analyze the prognostic factors.Methods Clinical data of 96 patients with K-Ras wild-type colorectal cancer with liver metastases admitted to Shougang Hospital of Peking University from January 2010 to January 2019 were retrospectively analyzed.Patients were divided into XELOX group(n=63)and combination group(n=33)according to treatment regimen.XELOX group was treated with XELOX chemotherapy regimen.In combination group,cetuximab was added to XELOX group.The therapeutic effect,survival and incidence of adverse reactions were compared between the two groups.Cox proportional risk regression model was used to analyze the prognostic factors.Results The objective response rate,disease control rate and rash incidence in the combination group were higher than those in the XELOX group,and the differences were statistically significant(P<0.05).There was no significant difference in median progression-free survival between the two groups(P>0.05).The median overall survival of the combination group was longer than that of the XELOX group,and the difference was statistically significant(P<0.05).Lymph node metastasis,tumor site and lactate dehydrogenase were independent prognostic factors for median overall survival(P<0.05).Conclusion Cetuximab combined with chemotherapy in the treatment of K-Ras wild-type colorectal cancer with liver metastases has a significant clinical effect,which can prolong the overall survival of patients.Lymph node metastasis,tumor site,and lactate dehydrogenase are effective prognostic factors.