靶向治疗与免疫治疗在结直肠癌中的应用效果比较

Comparison of clinical application effect of targeted therapy and immunotherapy in colorectal cancer

目的比较靶向治疗与免疫治疗在结直肠癌中的应用效果。方法依据治疗方案的不同将90例结直肠癌患者分为靶向治疗组(n=42)和免疫治疗组(n=48),靶向治疗组患者给予贝伐珠单抗治疗,免疫治疗组患者给予树突状细胞免疫治疗。比较两组患者的临床疗效、肿瘤标志物[癌胚抗原(CEA)、糖类抗原19-9(CA19-9)、糖类抗原72-4(CA72-4)]水平、免疫功能指标[CD3^(+)、CD4^(+)、CD8^(+)、自然杀伤(NK)细胞]水平、树突状标志物(包括CD1a、CD83)的相对表达量、生活质量[欧洲癌症研究与治疗组织生命质量测定量表(EORTC QLQ-C30)]、不良反应发生情况及预后情况。结果靶向治疗组患者的治疗总有效率为73.81%,高于免疫治疗组患者的56.25%(P﹤0.05)。治疗后,靶向治疗组患者CEA、CA19-9、CA72-4水平均明显低于免疫治疗组(P﹤0.01),CD3^(+)、CD4^(+)、CD8^(+)、NK细胞水平均明显高于免疫治疗组(P﹤0.01),CD1a相对表达量明显低于免疫治疗组(P﹤0.01),CD83相对表达量明显高于免疫治疗组(P﹤0.01)。治疗后,靶向治疗组患者EORTC QLQ-C30量表各维度评分均高于免疫治疗组(P﹤0.05),不良反应总发生率为4.76%,低于免疫治疗组患者的18.75%(P﹤0.05)。随访6个月,靶向治疗组患者的复发率、转移率分别为7.14%、4.76%,分别低于免疫治疗组患者的25.00%、20.83%(P﹤0.05)。结论靶向治疗可明显提高结直肠癌的临床疗效,改善免疫功能和生活质量,降低肿瘤标志物水平和不良反应发生率。

Objective To compare the clinical effect of targeted therapy and immunotherapy in colorectal cancer.Method According to different treatment regimens,90 patients with colorectal cancer were divided into targeted therapy group(n=42)and immunotherapy group(n=48).Patients in the targeted therapy group were treated with bevacizumab,and patients in the immunotherapy group were treated with dendritic cell immunotherapy.The clinical efficacy,tumor marker[carcinoembryonic antigen(CEA),carbohydrate antigen 19-9(CA19-9),carbohydrate antigen 72-4(CA72-4)]levels,immune function indicators[CD3^(+),CD4^(+),CD8^(+),natural killer(NK)cell]levels,relative expression of dendritic markers(CD1a and CD83),quality of life[European Organization for Research and Treatment of Cancer quality of life questionnaire core-30(EORTC QLQ-C30)],occurrence of adverse reactions and prognosis were compared between the two groups.Result The total effective rate of patients in the targeted therapy group was 73.81%,which was higher than 56.25% in the immunotherapy group(P<0.05).After treatment,the levels of CEA,CA19-9,CA72-4 in the targeted treatment group were significantly lower than those in the immunotherapy group(P<0.01),the levels of CD3^(+),CD4^(+),CD8^(+),NK cell were significantly higher than those in the immunotherapy group(P<0.01),the relative expression of CD1a was significantly lower than that in the immunotherapy group(P<0.01),and the relative expression of CD83 was significantly higher than that in the immunotherapy group(P<0.01).After treatment,the scores of each dimension of EORTC QLQC30 scale in the targeted therapy group were higher than those in the immunotherapy group(P<0.05),and the total incidence of adverse reactions was 4.76%,which was lower than 18.75%in the immunotherapy group(P<0.05).After 6 months of follow-up,the recurrence rate and metastasis rate of the targeted therapy group were 7.14% and 4.76%,respectively,which were lower than 25.00% and 20.83% of the immunotherapy group(P<0.05).Conclusion Targeted therapy can significantly improve the clinical efficacy of colorectal cancer,improve the immune function and quality of life,and reduce the level of tumor markers and the incidence of adverse reactions.