吉西他滨联合周疗法紫杉醇脂质体治疗晚期胃癌的疗效

Curative effect of gemcitabine combined with weeks therapy of paclitaxel liposome on advanced gastric cancer

目的探究吉西他滨联合周疗法紫杉醇脂质体治疗晚期胃癌的疗效。方法选取收治的晚期胃癌患者92例,用随机数字表法分为观察组(n=46)和对照组(n=46),对照组患者采用吉西他滨(1000 mg·m^(-2),d1,d8)联合顺铂(75 mg·m^(-2),d1)(GP方案)治疗,观察组患者在对照组治疗的基础上给予紫杉醇脂质体(175 mg·m^(-2),d1)治疗。2组均以21 d为1个疗程,共治疗2个疗程。比较2组患者治疗后的近期疗效及治疗前后的血清肿瘤标志物水平、免疫学指标;比较2组患者治疗后不良反应的发生情况及随访6个月的生存情况。结果观察组与对照组治疗后的总有效率分别为73.91%、63.04%,疾病控制率分别为93.48%、84.78%,2组总有效率与疾病控制率比较差异无统计学意义(P>0.05)。治疗后,2组患者血清E-钙黏连蛋白(E-cadhe-rin,E-cad)、癌胚抗原(carcino-embryonic antigen,CEA)、鳞状细胞癌抗原(squamous cell carcinoma antigen,SCCA)、糖类抗原19-9(carbohydrate antigen 19-9,CA19-9)及细胞角蛋白19片段抗原21-1(cytokeratin 19 fragment antigen 21-1,CYERA21-1)的水平较治疗前均明显下降(P<0.05),但2组上述指标比较差异无统计学意义(P>0.05)。治疗后,观察组CD3+、CD4+、CD4+/CD8+值及自然杀伤细胞(natural killer cell,NK)较对照组高,CD8+、调节性T细胞(regulatory T cells,Treg)、辅助性T细胞17(helper T cell 17,Th17)、Th17/Treg值较对照组低(P<0.05)。用药后观察组恶心呕吐、腹泻、血小板减少、肝肾功能损伤及外周神经毒性等的发生率均明显低于对照组(P<0.05)。观察组随访6个月的生存率明显高于对照组,中位生存期及无进展生存期均明显长于对照组(P<0.05)。结论吉西他滨联合周疗法紫杉醇脂质体治疗晚期胃癌的疗效显著,可明显改善患者血清肿瘤标志物的水平及免疫力,降低不良反应发生的风险,延长生存时间,具有一定的临床推广价值。

Objective To explore the curative effect of gemcitabine combined with weeks therapy of paclitaxel liposome on advanced gastric cancer.Methods A total of 92 patients with advanced gastric cancer admitted to the hospital were enrolled.According to random number table method,they were divided into observation group(n=46)and control group(n=46).The patients in control group were given gemcitabine(1000 mg·m^(-2),d1,d8)combined with cisplatin(75 mg·m^(-2),d1)as GP regimen,while those in observation group were additionally given paclitaxel liposome(175 mg·m^(-2),d1).All were treated for 2 courses of treatment,21 days per course.The short-term curative effect after treatment,levels of serum tumor markers and immunological indexes before treatment and after treatment,and the occurrence of adverse reactions after medication were compared between the 2 groups.The survival situations after 6 months of follow-up were observed.Results The total response rates of treatment in observation group and control group were 73.91%and 63.04%,respectively.The disease control rates in the 2 groups were 93.48%and 84.78%,respectively.There was no significant difference between the 2 groups in total response rate or disease control rate(P>0.05).After treatment,the levels of serum E-cadherin(E-cad),carcino-embryonic antigen(CEA),squamous cell carcinoma antigen(SCCA),carbohydrate antigen 19-9(CA19-9)and cytokeratin 19 fragment antigen 21-1(CYERA21-1)in both groups were significantly decreased(P<0.05),but there was no significant difference between the 2 groups(P>0.05).After treatment,the CD3+,CD4+,CD4+/CD8+and natural killer cells(NK)in observation group were higher than those in control group,while the CD8+,regulatory T cells(Treg),helper T cells 17(Th17)and Th17/Treg were lower than those in control group(P<0.05).After medication,the incidence of nausea and vomiting,diarrhea,thrombocytopenia,liver-kidney function damage and peripheral neurotoxicity in observation group was significantly lower than that in control group(P<0.05).After 6 months of follow-up,the survival rate in observation group was significantly higher than that in control group,the median survival time and progression-free survival time were significantly longer than those in control group(P<0.05).Conclusion The curative effect of gemcitabine combined with weeks therapy of paclitaxel liposome is significant on advanced gastric cancer,which can significantly improve the levels of serum tumor markers and immunity,reduce the risk of adverse reactions and prolong survival time.