吉西他滨联合DF化疗同步3D-CRT疗法对宫颈癌术后患者血清VEGF MMP-9水平的影响
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摘要
目的:探讨吉西他滨联合DF化疗方案同步三维适形放疗(3D-CRT)疗法在宫颈癌术后患者中应用效果。方法:选取我院2013年11月至2015年6月收治的宫颈癌术后患者90例,均采用同步3D-CRT疗法治疗,按照随机数字表法分组,对照组45例给予DF化疗方案治疗,观察组45例于对照组基础上给予吉西他滨治疗,观察比较两组治疗效果及治疗前后血清血管内皮生长因子(VEGF)、基质金属蛋白酶-9(MMP-9)水平、抑癌基因(Fas、p53)水平变化情况,并统计两组不良反应发生情况及预后(1年、2年、3年)生存率。结果:经Ridit检验观察组临床疗效优于对照组,且观察组疾病控制率为82.22%(37/45),高于对照组57.78%(26/45)(P<0.05);治疗后两组血清VEGF、MMP-9水平均明显低于治疗前,且治疗后观察组血清VEGF、MMP-9水平低于对照组(P<0.05);治疗后两组Fas、p53水平均明显高于治疗前,且治疗后观察组Fas、p53水平高于对照组(P<0.05);观察组白细胞减少(26.67%)、腹泻(31.11%)、恶心呕吐(37.78%)、血小板减少(44.44%)、脱发(57.78%)发生率与对照组比较,差异无统计学意义(P>0.05);观察组1年生存率为93.33%(42/45)、2年生存率为84.44%(38/45)、3年生存率为64.44%(29/45),对照组1年生存率为91.11%(41/45)、2年生存率为80.00%(36/45)、3年生存率为57.78%(26/45),组间比较差异无统计学意义(P>0.05)。结论:吉西他滨联合DF化疗方案同步3D-CRT疗法可改善宫颈癌术后患者血清VEGF、MMP-9水平,上调抑癌基因表达,提高疾病控制率,不良反应少。
Objective: To investigate the effect of simultaneous three-dimensional conformal radiotherapy(3D-CRT) with gemcitabine combined with DF chemotherapy in patients with cervical cancer. Methods: A total of 90 patients with cervical cancer who underwent surgery from November 2013 to June 2015 were enrolled in our hospital. All patients were treated with synchronous 3D-CRT therapy, grouped according to random number table, 45 patients in the control group were treated with DF chemotherapy. 45 patients in the study group were treated with gemcitabine on the basis of the control group. The therapeutic effects and serum vascular endothelial growth factor(VEGF), matrix metalloproteinase-9(MMP-9) levels, and tumor suppressor genes(Fas, p53), the level of change, and the incidence of adverse reactions and prognosis(1 year, 2 years, 3 years) survival rate were compared before and after treatment. Results: The clinical efficacy of the observation group was better than that of the control group, and the disease control rate was 82.22%(37/45) in the observation group, 57.78%(26/45) in the control group(P<0.05). The levels of VEGF and MMP-9 were significantly lower than those before treatment, and the levels of serum VEGF and MMP-9 in the observation group were lower than those in the control group(P<0.05). The levels of Fas and p53 in the two groups were significantly higher than those before treatment. The levels of Fas and p53 in the observation group were higher than those in the control group(P<0.05). The observation group had leukopenia(26.67%), diarrhea(31.11%), nausea and vomiting(37.78%), thrombocytopenia(44.44%), and hair loss. The incidence rate of 57.78% was not significantly different from that of the control group(P>0.05). The 1-year survival rate of the observation group was 93.33%(42/45), and the 2-year survival rate was 84.44%(38/45). The annual survival rate was 64.44%(29/45). The 1-year survival rate of the control group was 91.11%(41/45), the 2-year survival rate was 80.00%(36/45), and the 3-year survival rate was 57.78%(26/45) There was no significant difference between the groups(P>0.05). Conclusion: Synchronous 3 D-CRT therapy with gemcitabine combined with DF chemotherapy can improve serum VEGF and MMP-9 levels, up-regulate tumor suppressor gene expression, increase disease control rate, and have fewer adverse reactions.
Objective: To investigate the effect of simultaneous three-dimensional conformal radiotherapy(3D-CRT) with gemcitabine combined with DF chemotherapy in patients with cervical cancer. Methods: A total of 90 patients with cervical cancer who underwent surgery from November 2013 to June 2015 were enrolled in our hospital. All patients were treated with synchronous 3D-CRT therapy, grouped according to random number table, 45 patients in the control group were treated with DF chemotherapy. 45 patients in the study group were treated with gemcitabine on the basis of the control group. The therapeutic effects and serum vascular endothelial growth factor(VEGF), matrix metalloproteinase-9(MMP-9) levels, and tumor suppressor genes(Fas, p53), the level of change, and the incidence of adverse reactions and prognosis(1 year, 2 years, 3 years) survival rate were compared before and after treatment. Results: The clinical efficacy of the observation group was better than that of the control group, and the disease control rate was 82.22%(37/45) in the observation group, 57.78%(26/45) in the control group(P<0.05). The levels of VEGF and MMP-9 were significantly lower than those before treatment, and the levels of serum VEGF and MMP-9 in the observation group were lower than those in the control group(P<0.05). The levels of Fas and p53 in the two groups were significantly higher than those before treatment. The levels of Fas and p53 in the observation group were higher than those in the control group(P<0.05). The observation group had leukopenia(26.67%), diarrhea(31.11%), nausea and vomiting(37.78%), thrombocytopenia(44.44%), and hair loss. The incidence rate of 57.78% was not significantly different from that of the control group(P>0.05). The 1-year survival rate of the observation group was 93.33%(42/45), and the 2-year survival rate was 84.44%(38/45). The annual survival rate was 64.44%(29/45). The 1-year survival rate of the control group was 91.11%(41/45), the 2-year survival rate was 80.00%(36/45), and the 3-year survival rate was 57.78%(26/45) There was no significant difference between the groups(P>0.05). Conclusion: Synchronous 3 D-CRT therapy with gemcitabine combined with DF chemotherapy can improve serum VEGF and MMP-9 levels, up-regulate tumor suppressor gene expression, increase disease control rate, and have fewer adverse reactions.
引文
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[9] 陈明晓.吉西他滨联合放疗对老年中晚期宫颈癌患者的临床疗效及预后的影响[J].中国实用医刊,2017,44(18):107～109.
[10] 高雅丽,赵子申,高雅梅,等.同步放化疗后巩固化疗对局部晚期宫颈癌患者预后的影响[J].中国现代医药杂志,2016,18(2):25～29.
[11] 杨吉帆,任洪波,李春梅,等.替吉奥胶囊+康艾注射液+调强放疗对晚期宫颈癌病灶内细胞恶性生物学进程的影响[J].海南医学院学报,2017,23(17):2408～2411..
[2] Wright T C,Stoler M H,Behrens C M,et al.Primary cervical cancer screening with human papillomavirus:End of study results from the ATHENA study using HPV as the first-line screening test[J].Gynecol Oncol,2015,136(2):189～197.
[3] 杨宇箭,张译文,陈观美.顺铂联合吉西他滨或5-氟尿嘧啶辅助化疗对宫颈癌Ⅱb期宫颈鳞状细胞癌根治术疗效的影响[J].世界临床医学,2017,11(23):106～107.
[4] 蒋晓蓉,李万平,熊林.吉西他滨结合放、化疗对宫颈癌血管生成及侵袭能力的影响[J].中国药房,2017,28(11):1551～1554.
[5] 王福玲.世界医学会《赫尔辛基宣言》--涉及人类受试者的医学研究的伦理原则[J].中国医学伦理学,2016,29(3):544～546.
[6] 谢幸,苟文丽.妇产科学[M].第8版.北京:人民卫生出版社,2013.304～309.
[7] 张振中,魏睿,李飞,等.肿瘤靶向多肽TMTP1偶联阿霉素选择性地抑制高侵袭性宫颈癌细胞株生长的体外研究[J].现代妇产科进展,2017,26(9):651～655.
[8] 贾惠,翟红岩,冯燕,等.MMP-9和VEGF阳性表达与中晚期宫颈癌同步放化疗敏感性的关系[J].癌症进展,2017,15(8):920～922.
[9] 陈明晓.吉西他滨联合放疗对老年中晚期宫颈癌患者的临床疗效及预后的影响[J].中国实用医刊,2017,44(18):107～109.
[10] 高雅丽,赵子申,高雅梅,等.同步放化疗后巩固化疗对局部晚期宫颈癌患者预后的影响[J].中国现代医药杂志,2016,18(2):25～29.
[11] 杨吉帆,任洪波,李春梅,等.替吉奥胶囊+康艾注射液+调强放疗对晚期宫颈癌病灶内细胞恶性生物学进程的影响[J].海南医学院学报,2017,23(17):2408～2411..