多西他赛联合阿帕替尼二线治疗晚期非小细胞肺癌的疗效与安全性研究

Effect and safety of docetaxel combined with apatinib in second-line treatment of advanced non-small cell lung cancer

目的探讨多西他赛联合阿帕替尼二线治疗晚期非小细胞肺癌(NSCLC)的疗效与安全性。方法选取2018年3月至2020年2月汉中市中心医院肿瘤内科收治的NSCLC患者94例,采用随机数表法分为观察组和对照组,每组47例,对照组患者予以多西他赛治疗,观察组患者在对照组治疗基础上联合阿帕替尼治疗,均持续用药2个周期。疗程结束后比较两组患者的临床疗效,以及治疗前后的血清肿瘤标志物水平[细胞角蛋白19片段抗原21-1(CYFRA21-1)、癌胚抗原(CEA)、糖蛋白抗原125(CA125)及鳞状上皮细胞癌抗原(SCC)]、T淋巴细胞亚群CD3+、CD4+、CD8+水平和CD4+/CD8+值;记录两组患者治疗期间的不良反应发生情况;治疗后随访2年,比较两组患者的生存情况。结果观察组患者的临床治疗总有效率为48.94%,明显高于对照组的27.66%,差异有统计学意义(P<0.05);治疗后,观察组患者的CYFRA21-1、CEA、CA125及SCC水平分别为(2.26±0.87)ng/mL、(13.43±1.36)ng/mL、(24.51±3.71)U/mL及(1.24±0.31)mg/L,明显低于对照组的(5.37±1.05)ng/mL、(18.39±2.29)ng/mL、(32.19±3.20)U/mL及(3.36±0.94)mg/L,差异均有统计学意义(P<0.05);治疗后,观察组患者的CD3+、CD4+、CD4+/CD8+水平分别为(59.62±4.15)%、(38.12±4.88)%、1.61±0.27,明显高于对照组的(56.94±5.25)%、(35.25±4.34)%、1.32±0.24,CD8+水平为(20.54±2.58)%,明显低于对照组的(23.76±2.73)%,差异均有统计学意义(P<0.05);观察组患者治疗期间的不良反应总发生率为21.28%,略高于对照组的17.02%,但差异无统计学意义(P>0.05);观察组患者的2年生存率及无病生存率分别为40.43%及25.53%,明显高于对照组的27.66%及17.02%,差异有统计学意义(P<0.05)。结论多西他赛联合阿帕替尼二线治疗晚期NSCLC可提高患者临床疗效和免疫功能,降低肿瘤标志物水平,延长生存期。

Objective To explore and analyze the effect and safety of docetaxel combined with apatinib in second-line treatment of advanced non-small cell lung cancer(NSCLC).Methods A total of 94 patients with NSCLC admitted to Department of Oncology,Hanzhong Central Hospital between March 2018 and February 2020 were enrolled in the study.According to random number table method,they were divided into an observation group(n=47)and a control group(n=47).The patients in the control group were treated with docetaxel,while those in the observation group were additionally treated with apatinib on the basis of the treatment in the control group.All the patients were continuously treated for 2 cycles.The clinical curative effect after treatment,levels of serum tumor markers[cytokeratin 19 fragment antigen 21-1(CYFRA21-1),carcinoembryonic antigen(CEA),carbohydrate antigen 125(CA125),squamous cell carcinoma antigen(SCC)],T lymphocyte subsets CD3+,CD4+,CD8+,and CD4+/CD8+before and after treatment were compared between the two groups.The occurrence of adverse reactions in the two groups during treatment was recorded.The patients were followed up for 2 years after treatment.The survival conditions between the two groups were compared.Results The total response rate of clinical treatment in the observation group was significantly higher than that in the control group(48.94%vs 27.66%,P<0.05).After treatment,levels of CYFRA21-1,CEA,CA125,and SCC in the observation group were(2.26±0.87)ng/mL,(13.43±1.36)ng/mL,(24.51±3.71)U/mL,and(1.24±0.31)mg/L,significantly lower than(5.37±1.05)ng/mL,(18.39±2.29)ng/mL,(32.19±3.20)U/mL,(3.36±0.94)mg/L in the control group(P<0.05).After treatment,levels of CD3+,CD4+,and CD4+/CD8+in the observation group were(59.62±4.15)%,(38.12±0.05)%,and 1.61±0.27,significantly higher than(56.94±5.25)%,(35.25±4.34)%,1.32±0.24 in the control group(P<0.05),while CD8+was(20.54±2.58)%,significantly lower than(23.76±2.73)%in the control group(P<0.05).The total incidence of adverse reactions during treatment in the observation group was slightly higher than that in control group,but the difference was not statistically significant(21.28%vs 17.02%,P>0.05).The 2-year survival rate and disease-free survival rate in the observation group were 40.43%and 25.53%,significantly higher than 27.66%and 17.02%in the control group(P<0.05).Conclusion The second-line treatment of docetaxel combined with apatinib can improve clinical curative effect and immune function,reduce levels of tumor markers and prolong survival in patients with advanced NSCLC.