摘要
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.
引文
[1]梁敦波,温尊北,庞晓泳,等.宫颈癌术后调强适形放疗联合卡铂治疗效果观察[J].临床医学,2016,36(3):84-85.
[2]Huh WK,Ault KA,Chelmow D,et al.Use of primary high-risk human papillomavirus testing for cervical cancer screening:interim clinical guidance[J].Gynecol Oncol,2015,136(2):178-182.
[3]陈艳辉.紫杉醇联合卡铂化疗并同步放疗治疗中晚期宫颈癌近期及远期疗效[J].中国现代医生,2015,53(4):52-54.
[4]Speiser P,Wanner C,Tempfer C,et al.CD44 is an independent prognostic factor in early-stage cervical cancer[J].Int J Cancer,1997,74(2):185-188.
[5]郑铁桩.卡铂+氟尿嘧啶联合调强适形放疗治疗中晚期宫颈癌的实证分析[J].中国药物经济学,2014,6(5):78-79.
[6]汤锐明,刘殷红,王馨,等.不同剂量紫杉醇联合卡铂治疗局部晚期宫颈癌同期放化疗的疗效观察[J].中国医学创新,2017,14(12):69-72.
[7]李慧,郭荣,岳莎莎,等.紫杉醇联合卡铂同期放疗对高危险早期宫颈癌患者术后的临床疗效及安全性研究[J].中国实用医药,2016,11(35):17-18,19.
[8]宋丹,孔为民.紫杉醇联合卡铂治疗晚期及复发性宫颈癌的可行性研究[J].实用癌症杂志,2016,31(3):421-424.
[9]戈宝红,吴鸿,李东芳.黎月恒教授针药并用治疗宫颈癌术后顽固性尿潴留经验[J].湖南中医药大学学报,2016,36(5):49-51.
[10]Hsieh CY,Wu CC,Chen TM,et al.Clinical significance of intratumoral blood flow in cervical carcinoma assessed by color Doppler ultrasound[J].Cancer,1995,75(10):2518-2522.
[11]Takeda N,Sakuragi N,Takeda M,et al.Multivariate analysis of histopathologic prognostic factors for invasive cervical cancer treated with radical hysterectomy and systematic retroperitoneal lymphadenectomy[J].Acta Obstet Gynecol Scand,2002,81(12):1144-1151.
[12]李明成,吴方红,文静.紫杉醇联合卡铂治疗晚期与复发性宫颈癌的疗效及安全性[J].中国医院用药评价与分析,2016,16(12):1637-1638,1639.
[13]林佳.紫杉醇联合卡铂化疗并同步放疗治疗中晚期宫颈癌近期疗效观察[J].中国现代医药杂志,2017,19(2):72-74.
[14]Strickler HD,Kirk GD,Figueroa JP,et al.HPV 16 antibody prevalence in Jamaica and the United States reflects differences in cervical cancer rates[J].Int J Cancer,1999,80(3):339-344.
[15]苟晓莉,金晶,毕惠嫦,等.红豆杉枝叶提取物及紫杉烷类成分对4种肿瘤细胞的毒性作用研究[J].中国药理学通报,2016,32(4):591-592.
[16]Hu Z,Zhu D,Wang W,et al.Genome-wide profiling of HPV integration in cervical cancer identifies clustered genomic hot spots and a potential microhomology-mediated integration mechanism[J].Nat Genet,2015,47(2):158-163.
[17]李凤虎,杨飞月,常建英,等.宫颈癌紫杉醇联合洛铂或顺铂新辅助序贯洛铂或顺铂同步化放疗多中心随机临床研究[J].中华肿瘤防治杂志,2016,23(16):1090-1094.
[18]董耘,李斌,柯丽娜,等.宫颈癌患者腹腔镜术后应用动脉介入化疗的临床观察[J].中国药房,2016,27(2):222-224.
[19]唐秦,邢高升,彭君臣,等.杉醇联合铂类方案治疗中晚期宫颈癌的疗效[J].热带医学杂志,2016,16(2):213-216.
