紫杉醇配合卡铂在老年宫颈癌患者中的应用评价

Evaluation on the Application of Paclitaxel and Carboplatin to Elderly Patients with Cervical Cancer

目的:探讨紫杉醇联合卡铂应用于老年宫颈癌患者的临床治疗效果,分析老年宫颈癌最佳治疗手段。方法:选取2015年4月至2017年4月辽河油田总医院肿瘤科收治的宫颈癌老年患者102例作为研究对象,按照治疗方式不同,随机分为对照组(n=49)和观察组(n=53),对照组采取调强适形放疗(IMRT)治疗,观察组基于对照组增加紫杉醇配合卡铂治疗。在2组治疗前和治疗4周期后,观察2组病灶癌细胞增殖、血常规、肿瘤标志物指标变化,记录治疗4周期内的不良反应和疗效。结果:观察组红细胞(6. 71±0. 43)×1012/L、红细胞比容(Hct)(41. 92±1. 82)%、血小板(78. 15±3. 15)×109/L、中性粒细胞(51. 47±1. 42)%、白细胞(8. 41±0. 87)×109/L显著低于对照组,血红蛋白(160. 62±9. 45) g/L显著高于对照组(P <0. 05);观察组鳞状细胞癌抗原(SCC)(1. 15±0. 88) ng/m L、组织多肽特异抗原(TPS)(30. 62±3. 16) m U/m L、CA19-9(21. 92±1. 14) U/m L、细胞角蛋白21-1(Cyfra21-1)(26. 71±0. 97) ng/m L、癌胚抗原(CEA)(1. 47±0. 59)μg/m L、组织多肽抗原(TPA)(97. 41±8. 73) U/L、糖链抗原125(CA125)(20. 46±1. 59) U/m L显著低于对照组(P <0. 05);观察组新型共刺激分子B7-H4 (121. 81±9. 14)、低氧诱导因(HIF)-1α(126. 64±10. 97)、骨髓瘤细胞Sp2(130. 47±11. 59)、增殖细胞核抗原(PCNA)(120. 46±10. 59)显著低于对照组,PTEN基因(81. 73±4. 92)、抑癌基因FHIT(80. 78±4. 16)、斯钙素1(STC1)(77. 01±2. 73)显著高于对照组(P <0. 05);观察组有效率(RR)(64. 15%)、疗效(DCR)(96. 23%)均显著高于对照组(48. 98%)、(85. 71%)(P <0. 05);观察组用药后中医症状积分总分(4. 46±0. 59)分显著低于对照组(6. 97±0. 45)分(P <0. 05);观察组胃肠道反应、泌尿系统、骨髓抑制发生情况与对照组差异无统计学意义(P>0. 05)。结论:老年宫颈癌患者可采取IMRT序贯紫杉醇结合卡铂治疗,相比紫杉醇结合卡铂的治疗方案,能够提高疗效,减轻不良反应,促进血常规、病灶癌细胞增殖、肿瘤标志物指标的恢复。

Objective: To investigate the sequential paclitaxel combined with carboplatin in the treatment of elderly patients with cervical cancer and evaluate the clinical effects and analyze the best treatment for elderly patients with cervical cancer. Methods:A total of 102 cases of elderly patients with cervical cancer in Liaohe Oilfield General Hospital were selected from April 2015 to April 2017. According to the different treatment methods,they were randomly divided into the control group( 49 cases) and the observation group( 53 cases). The control group was given IMRT treatment. The experimental group,based on the control group,were added with paclitaxel combined with carboplatin. The lesions cancer cell proliferation,routine blood test and tumor marker changes were observed before the treatment and 4 cycles after treatment. The adverse reaction and efficacy were recorded within 4 cycles.Results: In the observation group,RBC( 6. 71 ± 0. 43) × 1012/L,HCT( 41. 92 ± 1. 82) %,PLT( 78. 15 ± 3. 15) × 109/L,N( 51. 47 ± 1. 42) %,WBC( 8. 41 ± 0. 87) × 109/L were significantly lower than that of the control group. HGB( 160. 62 ± 9. 45) g/L was significantly higher than that of the control group( P < 0. 05);In the observation group,SCC( 1. 15 ± 0. 88) ng/m L,TPS( 30. 62 ± 3. 16) m U/m L,CA19-9( 21. 92 ± 1. 14) U/m L,Cyfra21-1( 26. 71 ± 0. 97) ng/m L,CEA( 1. 47 ± 0. 59) μg/m L,TPA( 97. 41 ± 8. 73) U/L,CA125( 20. 46 ± 1. 59) U/m L were significantly lower than that of the control group( P < 0. 05);In the observation group,B7-H4( 121. 81 ± 9. 14),HIF-1α( 126. 64 ± 10. 97),Sp2( 130. 47 ± 11. 59),PCNA( 120. 46 ± 10. 59) were significantly lower than that of the control group. PTEN( 81. 73 ± 4. 92),FHIT( 80. 78 ± 4. 16),STC1( 77. 01 ± 2. 73) were significantly higher than that of the control group( P < 0. 05);In the experimental group,RR( 64. 15%),DCR( 96. 23%) were significantly higher than that of the control group,which are( 48. 98%),( 85. 71%)( P < 0. 05);The total score of TCM symptom score in the experimental group( 4. 46 ± 0. 59) was significantly lower than that of the control group( 6. 97 ± 0. 45)( P < 0. 05). There was no significant difference between the experimental group and the control group in the gastrointestinal reaction,urinary system,bone marrow suppression( P > 0. 05). Conclusion: For elderly patients with cervical cancer,the IMRT sequential paclitaxel combined with carboplatin can be used. Compared with paclitaxel and carboplatin treatment,it can improve the efficacy,reduce the adverse effects,and promote the recovery of blood routine and tumor markers as well as proliferation the lesions of cancer cells.