吉西他滨联合白蛋白结合型紫杉醇治疗晚期胰腺癌的临床疗效及其安全性

Clinical efficacy and safety of gemcitabine combined with albumin-bound paclitaxel in the treatment of advanced pancreatic cancer

目的 观察吉西他滨联合白蛋白结合型紫杉醇治疗晚期胰腺癌的临床疗效及其安全性。方法 回顾性选取 2017 年 1 月-2019 年 1 月湖南省直中医医院肿瘤科收治的晚期胰腺癌患者 85 例,根据治疗方法不同分为对照组( n = 42) 和研究组( n = 43) 。对照组予以吉西他滨治疗,研究组在对照组基础上联合白蛋白结合型紫杉醇治疗,2 组均接受 3 个疗程的化疗。比较 2 组临床疗效,治疗前后血清肿瘤标志物[癌胚抗原( CEA) 、糖类抗原 19-9( CA19-9) 、甲胎蛋白( AFP) ]水平、炎性因子[白介素 10( IL-10) 、肿瘤坏死因子 α( TNF-α) 及干扰素 γ( IFN-γ) ]水平,不良反应,中位生存期,随访 12 个月、24 个月累积生存率。结果 研究组客观缓解率( ORR) 、疾病控制率( DCR) 为65. 12% 、86. 05% ,高于对照组的 35. 71% 、66. 66% ( χ^(2)= 7. 348、4. 435,P = 0. 007、0. 035) 。治疗后,2 组血清 CEA、CA19-9、AFP 水平低于治疗前,且研究组低于对照组( P < 0. 05) 。治疗后,2 组血清 IL-10、TNF-α 水平低于治疗前,血清 IFN-γ 水平高于治疗前,且研究组 IL-10、TNF-α 水平低于对照组,血清 IFN-γ 水平高于对照组( P < 0. 05) 。研究组不良反应总发生率为 51. 16% ,与对照组的 54. 76% 比较,差异无统计学意义( χ^(2)= 0. 010,P = 0. 919) 。对照组和研究组患者的中位生存期分别为 13. 9 个月和 11. 2 个月。研究组 12 个月累积生存率为 88. 37% ,高于对照组的 66. 67%( χ^(2)= 5. 767,P = 0. 016) 。研究组 24 个月累积生存率为 67. 44% ,与对照组的 52. 38% 比较,差异无统计学意义( χ^(2)=2. 008,P = 0. 156) 。结论 吉西他滨联合白蛋白结合型紫杉醇治疗晚期胰腺癌的疗效确切,可有效抑制 CEA、CA19-9、AFP 表达,减轻炎性反应,延长患者生存时间,提高生存率,且安全性较高。

Objective To observe the clinical efficacy and safety of gemcitabine combined with albumin-bound paclitaxel in the treatment of advanced pancreatic cancer. Methods A total of 85 cases of patients with advanced pancreatic cancer were retrospectively selected from January 2017 to January 2019 in Hunan Provincial Direct of Traditional Chinese Medicine,which were divided into control group( n = 42) and study group ( n = 43) according to different treatment methods. The control group was treated with gemcitabine and the study group was treated with albumin-bound paclitaxel on the basis of the control group. Both groups received three courses of chemotherapy. Clinical efficacy,serum tumor markers[carcinoembryonic antigen ( CEA ) , carbohydrate antigen 19-9 ( CA19-9 ) , alpha fetoprotein ( AFP) ] levels, serum inflammatory factors[interleukin 10( IL-10) ,tumor necrosis factor α( TNF-α) and interferon γ( IFN-γ) ] levels before and after treatment,adverse reactions,cumulative survival rates at 12 and 24 months of follow-up were compared between the two groups. Results ORR and DCR in the study group were 65. 12% and 86. 05% ,which were higher than 35. 71% and 66. 66% in the control group( χ^(2)= 7. 348,4. 435;P = 0. 007,0. 035) . After treatment,the levels of serum CEA,CA19-9 and AFP in the two groups were lower than those before treatment,and those in the study group were lower than those in the control group( P <0. 05) . After treatment,the levels of serum IL-10 and TNF-α in the two groups were lower than those before treatment,and serum IFN-γ level was higher than that before treatment,and the levels of IL-10 and TNF-α in the study group were lower than those in the control group,but IFN-γ level was higher than that in the control group ( P < 0. 05 ) . The total incidence of adverse reactions in the study group was 51. 16% ,which was not statistically significant compared with 54. 76% in the control group( χ^(2)= 0. 010,P = 0. 919 ) . The median survival time of patients in the control group and the study group were13. 9 months and 11. 2 months,respectively. The 12-month cumulative survival rate of the study group was 88. 37% ,which was higher than 66. 67% in the control group( χ^(2)= 5. 767,P = 0. 016) . The 24-month cumulative survival rate of the study group was 67. 44% ,which was not statistically significant compared with 52. 38% of the control group ( χ^(2)= 2. 008,P =0. 156) . Conclusion Gemcitabine combined with albumin-bound paclitaxelhave an exact clinical effect for advanced pancreatic cancer,which can effectively inhibit the expression of CEA,CA19-9 and AFP,reduce the inflammatory reaction,prolong the survival time,promote survival rate of patients,and has high safety.