奥沙利铂联合卡培他滨对结肠癌术后辅助化疗的临床疗效及血清CD3^(+)、CD4^(+)、CD8^(+)水平的影响

Effect of Oxaliplatin Combined with Capecitabine on Clinical Efficacy of Postoperative Adjuvant Chemotherapy for Colon Cancer and Serum CD3+,CD4+and CD8+Levels

目的分析奥沙利铂联合卡培他滨对结肠癌术后辅助化疗的临床疗效及血清CD3^(+)、CD4^(+)、CD8^(+)水平的影响。方法选取2015年1月至2016年6月在廊坊市人民医院接受手术治疗的88例结肠癌患者作为研究对象,按照随机数字法分为对照组和观察组,每组44例。其中,对照组术后应用卡培他滨辅助化疗,每次1250 mg/m^(2),每日2次;观察组在对照组的基础上联合应用奥沙利铂辅助化疗,每次130 mg/m^(2),每日1次。两组均21 d为1个疗程,共治疗3个疗程。比较两组患者的临床疗效,化疗前后的血清T淋巴细胞亚群CD3^(+)、CD4^(+)、CD8^(+)和肿瘤标志物[癌胚抗原(CEA)、糖类抗原(CA)125、CA199]水平变化,化疗期间的不良反应发生情况及术后随访3年的生存情况。结果观察组的总有效率高于对照组[75.0%(33/44)比54.5%(24/44)](P<0.05)。化疗后,两组的血清CD3^(+)、CD4^(+)水平升高,且观察组高于对照组[(59.5±5.4)%比(55.4±4.5)%,(41.3±5.0)%比(37.0±5.3)%];CD8^(+)水平降低,且观察组低于对照组[(21.0±2.2)%比(24.4±2.4)%](均P<0.05)。化疗后,两组的CEA、CA125及CA199水平均降低,且观察组低于对照组[(12.8±1.1)μg/L比(16.9±1.1)μg/L,(28.8±2.1)kU/L比(31.2±2.1)kU/L,(24.2±4.1)kU/L比(27.9±3.9)kU/L](均P<0.05)。两组的肝功能异常、骨髓抑制、胃肠道反应、神经毒性、脱发的发生率比较差异无统计学意义(P>0.05)。Kaplan-Meier生存分析结果显示,观察组中位时间为22个月,对照组中位时间为18个月,两组患者术后的无进展生存曲线比较差异有统计学意义(P<0.05)。结论结肠癌术后患者应用奥沙利铂联合卡培他滨辅助化疗的临床疗效优于单用卡培他滨,可有效改善血清CD3^(+)、CD4^(+)、CD8^(+)水平,降低CEA、CA125及CA199水平,提高患者生存率,且未明显增加不良反应。

Objective To analyze the effect of oxaliplatin combined with capecitabine as adjuvant chemotherapy for colon cancer after operation and the influence on serum CD3^(+),CD4^(+),CD8^(+) levels.Methods A total of 88 patients with colon cancer who received surgical treatment in Langfang People′s Hospital from Jan.2015 to Jun.2016 were included.According to random number table method,the patients were divided into a control group and an observation group,44 patients each.The control group received adjuvant chemotherapy after surgery,1250 mg/m^(2) each time,twice a day;while the observation group was combined with oxaliplatin adjuvant chemotherapy on the basis of the control group,130 mg/m^(2),once a day.Both groups were treated for 21 days as a course of treatment,a total of 3 courses of treatment.The clinical efficacy of the two groups was compared,including the changes of serum T lymphocytes CD3^(+),CD4^(+),CD8^(+) and tumor markers[carcinoembryonic antigen(CEA),carbohydrate antigen(CA)125,CA199]levels before and after chemotherapy,the occurrence of adverse reactions during chemotherapy,and the 3-year postoperative survival.Results The total effective rate of the observation group was higher than that of the control group[75.0%(33/44)vs 54.5%(24/44)](P<0.05).After chemotherapy,the serum CD3^(+)and CD4^(+) levels in both groups were increased,and the observation group was higher than the control group[(59.5±5.4)%vs(55.4±4.5)%,(41.3±5.0)%vs(37.0±5.3)%];the level of CD8^(+) in the observation group was lower than that in the control group[(21.0±2.2)%vs(24.4±2.4)%](all P<0.05).After chemotherapy,CEA,CA125 and CA199 levels in both groups were decreased,and the observation group was lower than the control group[(12.8±1.1)μg/L vs(16.9±1.1)μg/L,(28.8±2.1)kU/L vs(31.2±2.1)kU/L,(24.2±4.1)kU/L vs(27.9±3.9)kU/L](all P<0.05).There were no significant differences in the incidence of abnormal liver function,bone marrow suppression,gastrointestinal reactions,neurotoxicity and alopecia between the two groups(P>0.05).Kaplan-meier survival analysis showed that the median time in the observation group was 22 months,and the median time in the control group was 18 months.The difference in the progression-free survival curve between the two groups was statistically significant(P<0.05).Conclusion The clinical efficacy of oxaliplatin combined with capecitabine in postoperative patients with colon cancer is better than that of capecitabine alone,which can effectively improve the serum levels of CD3^(+),CD4^(+),CD8^(+),reduce CEA,CA125 and CA199 levels,improve the survival rate,without significantly increasing the incidence of adverse reactions.