贝伐珠单抗联合FOLFIRI方案治疗微卫星稳定型晚期复发左、右半结直肠癌的疗效对比

Comparative analysis of the effectiveness of bevacizumab plus FOLFIRI regimen in the treatment of microsatellite stable type,advanced left-sided and right-sided colorectal cancer

目的探讨应用贝伐珠单抗联合FOLFIRI方案治疗微卫星稳定(MSS)型晚期复发左、右半结直肠癌的疗效差异。方法回顾性分析徐州医科大学附属医院2018年9月—2021年12月收治的58例一线应用贝伐珠单抗联合FOLFIRI方案治疗的MSS型晚期复发左、右半结直肠癌患者的临床资料,比较MSS型左、右半结直肠癌患者的临床特征、总生存时间(OS)、无进展生存时间(PFS)、疾病控制率(DCR)、客观缓解率(ORR)及1、2年生存率。结果MSS型晚期右半结肠癌患者合并不完全肠梗阻所占比例更高(P<0.05),MSS型晚期右半结肠癌患者较左半结直肠癌患者更易合并贫血及体重下降>5 kg(均P<0.05),肿瘤最大直径≥5 cm的右半结肠癌患者所占比例较左半结直肠癌患者高(P<0.05);左半结直肠癌患者中男性患者占比小于右半结肠癌患者(P<0.05)。2组治疗后癌胚抗原(CEA)和糖类抗原199(CA199)较治疗前明显下降(均P<0.05)。右半结肠癌组发生肝转移患者所占比例高于左半结直肠癌组(P<0.05)。左半结直肠癌组与右半结肠癌组ORR分别为14.8%和29.0%(P<0.05),DCR分别为74.1%和87.1%,差异无统计学意义(P>0.05)。左半结直肠癌组的1、2年生存率分别为92.6%、81.4%,右半结肠癌组分别为83.8%、61.3%,差异有统计学意义(P<0.05)。左半结直肠癌组的中位PFS长于右半结肠癌组(13.7个月vs 10.1个月,P<0.05),左半结直肠癌组的中位OS也明显长于右半结肠癌组(35.3个月vs 27.2个月,P<0.05),预后相对较好。结论应用贝伐珠单抗联合FOLFIRI方案治疗MSS型晚期复发结直肠癌患者,左、右半结直肠癌患者的临床特征、转移部位及生存状况存在差异。

Objective To explore the difference in the effectiveness of bevacizumab combined with FOLFIRI regimen for the treatment of microsatellite stable(MSS)type,advanced recurrent left-sided and right-sided colorectal cancer.Methods A total of 58 patients who were admitted to the Affiliated Hospital of Xuzhou Medical University from September 2018 to December 2021 due to MSS-type advanced recurrent left-sided and right-sided colorectal cancer and treated with first-line bevacizumab plus FOLFIRI regimen were selected,and their clinical data were retrospectively analyzed.Their clinical characteristics,overall survival time(OS),progression-free survival(PFS),disease control rate(DCR),objective remission rate(ORR),and 1-and 2-year survival rates were compared.Results The proportion of MSS-type advanced right-sided colorectal cancer patients with combined incomplete bowel obstruction was higher(P<0.05).MSS-type advanced right-sided colon cancer patients were more likely to have combined anemia and weight loss>5 kg than left-sided colorectal cancer patients(both P<0.05).The proportion of right-sided colon cancer patients with a maximum tumor diameter of≥5 cm was higher than that of left-sided colorectal cancer patients(P<0.05).The proportion of male patients in left-sided colorectal cancer patients was lower than that of right-sided colon cancer patients(P<0.05).After treatment,both groups showed remarkable decreases in carcinoembryonic antigen(CEA)and glycan antigen 199(CA199),compared with those before treatment(P<0.05).The proportion of patients who developed liver metastasis was higher in the right-sided colon cancer group than that in the left-sided colorectal cancer group(P<0.05).The ORR in the left-sided and the right-sided colorectal cancer groups was 14.8%and 29.0%,respectively(P>0.05),and the DCR was 74.1%and 87.1%(P>0.05),respectively.The 1-and 2-year survival rates were 92.6%and 81.4%in the left-sided colorectal cancer group and 83.8%and 61.3%in the right-sided colon cancer group,respectively(P<0.05).The left-sided colorectal cancer group presented better median PFS than the right-sided colon cancer group,with better prognosis(13.7 months vs 10.1 months,P<0.05).The median OS in the left-sided colorectal cancer group was also significantly better than that in the right-sided colon cancer group(35.3 months vs 27.2 months,P<0.05).Conclusions The application of bevacizumab plus FOLFIRI regimen for the treatment of patients with MSS-type advanced recurrent colorectal cancer brings about differences in clinical features,metastatic sites and survival between the left-sided and right-sided colorectal cancers.