重组人血管内皮抑制素注射液和三维适形调强放射治疗联合治疗食管癌疗效观察

Effect of recombinant human endostatin injection combined with three-dimensional conformal modulating radiotherapy in the treatment of esophageal cancer

目的探讨重组人血管内皮抑制素注射液和三维适形调强放射治疗联合治疗食管癌的临床效果。方法选择2017年6月至2020年2月南阳市中心医院收治的86例食管癌患者为研究对象,采用随机数字表法将患者分为观察组和对照组,每组43例。2组患者均给予营养支持、保肝、抑酸等常规治疗措施,在常规治疗基础上,对照组患者给予三维适形调强放射治疗,观察组患者给予重组人血管内皮抑制素注射液和三维适形调强放射治疗联合治疗。治疗后评估2组患者治疗效果,并观察治疗期间患者不良反应发生情况。对2组患者治疗前后血清中癌胚抗原(CEA)、细胞角质蛋白19片段抗原21-1(CYFRA21-1)、鳞状上皮细胞癌抗原(SCCA)、血管内皮生长因子(VEGF)、表皮生长因子受体(EGFR)、转化生长因子-β_(1)(TGF-β_(1))水平及外周血CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平和患者生活质量量表(QLQ-30)评分进行比较。结果观察组和对照组患者总有效率分别为72.09%(31/43)、51.16%(22/43),观察组患者治疗总有效率显著高于对照组(χ^(2)=3.983,P<0.05)。治疗期间,观察组患者放射性食管炎、血液毒性、食管狭窄、气管炎的发生率分别为30.23%(13/46)、13.95%(6/46)、2.33%(1/46)、9.30%(4/46),对照组患者放射性食管炎、血液毒性、食管狭窄、气管炎的发生率分别为53.49%(23/46)、32.56%(14/46)、4.65%(2/46)、20.93%(9/46);观察组患者放射性食管炎、血液毒性发生率显著低于对照组(χ^(2)=4.778、4.170,P<0.05),2组患者食管狭窄、气管炎发生率比较差异无统计学意义(χ^(2)=0.001、2.266,P>0.05)。2组患者治疗前血清CEA、CYFRA21-1、SCCA水平比较差异无统计学意义(P>0.05);2组患者治疗后血清CEA、CYFRA21-1、SCCA水平显著低于治疗前(P<0.05);治疗后,观察组患者血清CEA、CYFRA21-1、SCCA水平显著低于对照组(P<0.05)。2组患者治疗前CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平比较差异无统计学意义(P>0.05),观察组患者治疗前后CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平比较差异无统计学意义(P>0.05);与治疗前比较,对照组患者治疗后CD4^(+)、CD4^(+)/CD8^(+)水平显著降低,CD8^(+)水平显著升高(P<0.05)。治疗后,观察组患者CD4^(+)、CD4^(+)/CD8^(+)水平显著高于对照组,CD8^(+)水平显著低于对照组(P<0.05)。2组患者治疗前血清VEGF、EGFR、TGF-β_(1)水平比较差异无统计学意义(P>0.05),2组患者治疗后血清VEGF、EGFR、TGF-β_(1)水平显著低于治疗前(P<0.05);治疗后,观察组患者血清VEGF、EGFR、TGF-β_(1)水平显著低于对照组(P<0.05)。2组患者治疗前QLQ-30评分比较差异无统计学意义(P>0.05),2组患者治疗后QLQ-30评分显著高于治疗前(P<0.05);治疗后,观察组患者QLQ-30评分显著高于对照组(P<0.05)。结论重组人血管内皮抑制素注射液联合三维适形调强放射治疗可有效下调血清肿瘤标志物表达,抑制肿瘤生长,改善患者免疫功能和生存质量,降低不良反应发生率。

Objective To investigate the clinical effect of recombinant human endostatin injection combined with three-dimensional conformal modulating radiotherapy in the treatment of esophageal cancer.Methods A total of 86 patients with esophageal cancer treated in Nanyang Central Hospital from June 2017 to February 2020 were selected as the research subjects,and the patients were divided into observation group and control group by random number table,with 43 cases in each group.The patients in the two groups were treated with routine treatment measures such as nutritional support,liver protection and acid suppression.On the basis of routine treatment,the patients in the control group were treated with three-dimensional conformal modulating radiotherapy,and the patients in the observation group were treated with recombinant human endostatin injection and three-dimensional conformal modulating radiotherapy.The therapeutic effects of patients in the two groups were evaluated after treatment,and the occurrence of adverse reactions during treatment was observed.The levels of carcinoembryonic antigen(CEA),cytokeratin 19 fragment antigen 21-1(CYFRA21-1),squamous cell carcinoma antigen(SCCA),vascular endothelial growth factor(VEGF),epidermal growth factor receptor(EGFR),transforming growth factor-β_(1)(TGF-β_(1))in serum and CD4^(+),CD8^(+),CD4^(+)/CD8^(+)in peripheral blood and quality of life questionnaire 30(QLQ-30)scores were compared between the two groups before and after treatment.Results The total effective rate in the observation group and control group was 72.09%(31/43)and 51.16%(22/43),respectively.The total effective rate in the observation group was significantly higher than that in the control group(χ^(2)=3.983,P<0.05).During the treatment,the incidence rates of radiation esophagitis,hematotoxicity,esophageal stenosis and tracheitis in the observation group were 30.23%(13/46),13.95%(6/46),2.33%(1/46)and 9.30%(4/46),respectively.The incidence rates of radiation esophagitis,hematotoxicity,esophageal stenosis and tracheitis in the control group were 53.49%(23/46),32.56%(14/46),4.65%(2/46),20.93%(9/46),respectively.The incidence rates of radiation esophagitis and hematotoxicity in the observation group were significantly lower than those in the control group(χ^(2)=4.778,4.170;P<0.05).There was no significant difference in the incidences of esophageal stenosis and tracheitis between the two groups(χ^(2)=0.001,2.266;P>0.05).There was no significant difference in serum CEA,CYFRA21-1 and SCCA levels between the two groups before treatment(P>0.05).The levels of serum CEA,CYFRA21-1 and SCCA after treatment were significantly lower than those before treatment in the two groups(P<0.05).The levels of serum CEA,CYFRA21-1 and SCCA in the observation group were significantly lower than those in the control group after treatment(P<0.05).There was no significant difference in the levels of CD4^(+),CD8^(+),CD4^(+)/CD8^(+)between the two groups before treatment(P>0.05).There was no significant difference in the levels of CD4^(+),CD8^(+),CD4^(+)/CD8^(+)in the observation group before and after treatment(P>0.05).Compared with before treatment,the levels of CD4^(+),CD4^(+)/CD8^(+)in the control group decreased significantly after treatment,and the level of CD8^(+)increased significantly(P<0.05).After treatment,the levels of CD4^(+),CD4^(+)/CD8^(+)in the observation group were significantly higher than those in the control group,and the level of CD8^(+)was significantly lower than that in the control group(P<0.05).There was no significant difference in the levels of serum VEGF,EGFR and TGF-β_(1) between the two groups before treatment(P>0.05).The levels of serum VEGF,EGFR and TGF-β_(1) after treatment were significantly lower than those before treatment in the two groups(P<0.05).After treatment,the levels of serum VEGF,EGFR and TGF-β_(1) in the observation group were significantly lower than those in the control group(P<0.05).There was no significant difference in QLQ-30 score of patients between the two groups before treatment(P>0.05).The QLQ-30 score of patients after treatment was significantly higher than that before treatment in the two groups(P<0.05).After treatment,the QLQ-30 score of patients in the observation group was significantly higher than that in the control group(P<0.05).Conclusion Recombinant human endostatin injection combined with three-dimensional conformal modulating radiotherapy can effectively down regulate the expression of serum tumor markers,inhibit tumor growth,improve patients′immune function and quality of life,and reduce the incidence of adverse reactions.