mFOLFOX方案联合贝伐珠单抗在转移性结直肠癌一线治疗中的应用

Application of mFOLFOX Regimen Combined with Bevacizumab in First-line Treatment of Metastatic Colorectal Cancer

探讨mFOLFOX方案联合贝伐珠单抗在转移性结直肠癌(mCRC)一线治疗中的应用价值。纳入本院2018年5月~2021年5月收治的转移性结直肠癌患者120例,随机分成贝伐珠单抗组与对照组各60例。对照组采用mFOLFOX6方案,贝伐珠单抗组采用mFOLFOX6方案联合贝伐珠单抗治疗。在治疗3个月后,比较两组近期疗效,分别于治疗前及治疗3个月,比较两组肿瘤细胞凋亡指数以及血清癌胚抗原(CEA)、糖类抗原199(CA199)、糖类抗原72-4(CA72-4)、血管内皮生长因子(VEGF)、环氧化酶-2(COX-2)、基质金属蛋白酶-9(MMP-9)、脱嘌呤脱嘧啶核酸内切酶1(APE1)蛋白、S100钙离子结合蛋白A9(S100A9)水平,并记录两组毒副作用发生率。以患者治疗d 1开始随访,随访至2022年5月,比较两组中位生存时间。贝伐珠单抗组(86.67%)疾病控制率高于对照组(71.67%)(P<0.05)。两组治疗后血清CEA、CA199、CA72-4水平低于治疗前,贝伐珠单抗组较常规组降低(P<0.05)。两组治疗后肿瘤细胞凋亡指数较治疗前增高,贝伐珠单抗组高于常规组(P<0.05)。两组治疗后血清VEGF、COX-2、MMP-9、APE1蛋白、S100A9水平低于治疗前,其中贝伐珠单抗组低于对照组(P<0.05)。两组肝损害、血小板减少、周围神经毒性、恶心呕吐、白细胞减少、蛋白尿、高血压发生率比较无差异(P>0.05)。贝伐珠单抗组(20个月)中位生存期长于对照组(14个月)(P<0.05)。mFOLFOX6方案与贝伐珠单抗联合应用,能更有效提高mCRC患者的疾病控制率,改善肿瘤标记物水平,并下调血清VEGF、COX-2、MMP-9、APE1蛋白、S100A9水平,未增加毒副作用发生风险,且可延长中位生存期。

To investigate the application value of mFOLFOX regimen combined with bevacizumab in the first-line treatment of metastatic colorectal cancer(mCRC),a total of 120 patients with metastatic colorectal cancer admitted to the hospital from May 2018 to May 2021 were included and randomly divided into bevacizumab group and control group,60 cases in each group.The control group was only treated with mFOLFOX regimen(mFOLFOX6 regimen was used this time),and the bevacizumab group was treated with mFOLFOX6 regimen combined with bevacizumab.After 3 months of treatment,the short-term efficacy of the two groups was compared.Before and after 3 months of treatment,the apoptosis index of tumor cells and serum carcinoembryonic antigen(CEA),carbohydrate antigen 199(CA199),carbohydrate antigen 72-4(CA72-4),vascular endothelial growth factor(VEGF),cyclooxygenase-2(COX-2),matrix metalloproteinase-9(MMP-9),Apurinic apyrimidinic endonuclease 1(APE)were compared between the two groups.Protein and S100 calcium-binding protein A9(S100A9)levels,and the incidence of toxic and side effects in the two groups were recorded.Patients were followed up from the first day of treatment to May 2022,and the median survival time was compared between the two groups.The disease control rate of the bevacizumab group(86.67%)was higher than that of the control group(71.67%)(P<0.05).The levels of serum CEA,CA199 and CA72-4 in the two groups after treatment were lower than those before treatment,and the bevacizumab group was lower than the control group(P<0.05).The apoptosis index of tumor cells in the two groups after treatment was higher than that before treatment,and the bevacizumab group was higher than that in the control group(P<0.05).The serum levels of VEGF,COX-2,MMP-9,APE1 protein and S100A9 in the two groups after treatment were lower than those before treatment,and those in bevacizumab group were lower than those in control group(P<0.05).There were no differences in the incidence of liver damage,thrombocytopenia,peripheral neurotoxicity,nausea and vomiting,leukopenia,proteinuria and hypertension between the two groups(P>0.05).The median survival time of bevacizumab group(20 months)was longer than that of control group(14 months)(P<0.05).mFOLFOX6 regimen combined with bevacizumab can effectively improve the disease control rate of mCRC patients,improve the level of tumor markers,and down-regulate the levels of serum VEGF,COX-2,MMP-9,APE1 protein and S100A9,without increasing the risk of toxic side effects,and prolong the median survival time.