DOS辅助化疗对进展期胃癌患者术后免疫功能的影响
|
摘要
目的探讨DOS辅助化疗对进展期胃癌患者术后免疫功能的影响。方法选取2016年1月～2017年10月我院收治的71例进展期胃癌患者的临床资料进行回顾性分析。按照治疗方式的不同分为研究组(n=36)和对照组(n=35)。对照组患者直接进行开腹胃癌根治术治疗。研究组患者在手术前给予DOS辅助化疗治疗,治疗3个化疗周期后休息4周,然后进行手术治疗。对比两组的疗效。记录两组的手术情况,包括手术时间、术中失血量、淋巴结清扫数目、R0手术切除情况。检测两组的免疫功能指标(CD3~+、CD4~+、CD4~+/CD8~+、NK细胞)的水平。结果两组的缓解率比较,差异无统计学意义(P>0.05);观察组的总有效率比对照组高,差异有统计学意义(P<0.05);两组治疗后的CD3~+、CD4~+、CD4~+/CD8~+、NK细胞显著降低(P<0.05);观察组治疗后的CD3~+、CD4~+、CD4~+/CD8~+、NK细胞比对照组高,差异有统计学意义(P<0.05);两组的手术时间、术中失血量、淋巴结清扫数目无明显差异,差异无统计学意义(P>0.05);观察组的R0切除率比对照组高,差异有统计学意义(P<0.05)。结论 DOS辅助化疗能提高进展期胃癌的临床疗效,改善患者免疫功能,降低肿瘤标志物水平。
Objective To investigate the effect of DOS adjuvant chemotherapy on postoperative immunologic function in patients with advanced gastric cancer. Methods Clinical data of 71 patients with advanced gastric cancer admitted to our hospital from January 2016 to October 2017 were analyzed. According to the different treatment approaches, patients were divided into experiment group(n=36) and control group(n=35). Patients in control group were treated with radical gastrectomy for gastric cancer. Patients in experiment group had been treated with three rounds of DOS adjuvant chemotherapy followed by a 4-week break before surgery. Two groups were compared in surgery outcomes, including operation time, blood loss during surgery, number of dissected lymph nodes, and R0 resection state. Indicators for immunologic function(CD3~+, CD4~+, CD4~+/CD8~+, and NK cells) were measured in both groups. Results There was no significant difference in the remission rate between the two groups(P>0.05). CD3~+, CD4~+, CD4~+/CD8~+, and NK cells for both groups were significantly lower after treatment(P<0.05), but CD3~+, CD4~+, CD4~+/CD8~+were significantly higher for exper iment group than control group(P<0.05); No significant difference was observed between two groups in operation time,blood loss and numbers of dissected lymph nodes(P>0.05).R0 resection rate for experiment group was higher than that of control group, and the difference was statistically significant(P<0.05). Conclusion DOS adjuvant chemotherapy can improve clinical efficacy of treatment for advanced gastric cancer, enable better immunologic function and lower levels of tumor markers.
Objective To investigate the effect of DOS adjuvant chemotherapy on postoperative immunologic function in patients with advanced gastric cancer. Methods Clinical data of 71 patients with advanced gastric cancer admitted to our hospital from January 2016 to October 2017 were analyzed. According to the different treatment approaches, patients were divided into experiment group(n=36) and control group(n=35). Patients in control group were treated with radical gastrectomy for gastric cancer. Patients in experiment group had been treated with three rounds of DOS adjuvant chemotherapy followed by a 4-week break before surgery. Two groups were compared in surgery outcomes, including operation time, blood loss during surgery, number of dissected lymph nodes, and R0 resection state. Indicators for immunologic function(CD3~+, CD4~+, CD4~+/CD8~+, and NK cells) were measured in both groups. Results There was no significant difference in the remission rate between the two groups(P>0.05). CD3~+, CD4~+, CD4~+/CD8~+, and NK cells for both groups were significantly lower after treatment(P<0.05), but CD3~+, CD4~+, CD4~+/CD8~+were significantly higher for exper iment group than control group(P<0.05); No significant difference was observed between two groups in operation time,blood loss and numbers of dissected lymph nodes(P>0.05).R0 resection rate for experiment group was higher than that of control group, and the difference was statistically significant(P<0.05). Conclusion DOS adjuvant chemotherapy can improve clinical efficacy of treatment for advanced gastric cancer, enable better immunologic function and lower levels of tumor markers.
引文
[1]陈丽苹,贾鑑慧,于清蕊.进展期胃癌辅助治疗的现状与进展[J].医学与哲学,2016,37(6):58-60.
[2]葛清萌,戴少华,赵顺林.中上部进展期胃癌术后复发的危险因素分析[J].华南国防医学杂志,2018,10(2):97-100.
[3]杨娟,燕速.影响进展期胃癌新辅助化疗患者临床疗效的危险因素[J].实用癌症杂志,2017,32(5):770-772.
[4]中华人民共和国卫生部医政司.胃癌诊疗规范(2011版)[J].中国医学前沿杂志(电子版),2012,4(5):62-67.
[5]中华人民共和国国家卫生和计划生育委员会.胃癌规范化诊疗指南(试行)[J].中国医学前沿杂志(电子版),2013,4(8):56-63.
[6]季加孚,季鑫,步召德.从规范化到精准化:胃癌手术治疗的发展[J].中华外科杂志,2016,54(3):164-168.
[7]宋杰,陈凤格,赵伟,等.胃癌的发病率现状与治疗研究进展[J].中国慢性病预防与控制,2016,24(9):704-707.
[8]姚慰峰.新辅助化疗对进展期胃癌临床分期及肿瘤相关标记物的影响[J].贵州医药,2016,40(8):835-837.
[9]宋华勇,张帆,马磊.术前新辅助化疗对进展期胃癌手术清除率及并发症的影响[J].医学临床研究,2016,33(10):1943-1945.
[10]王鑫昊,李云龙.靶向药物在进展期胃癌中的研究进展[J].中国医药,2017,12(2):316-320.
[11]梁华,李春艳,张海梅,等.DOS方案新辅助化疗治疗局部晚期胃癌的疗效及安全性研究[J].癌症进展,2018,16(3):345-348.
[12]陈亚妮,胡海峰.DOS方案和SOX方案用于胃癌新辅助化疗的癌细胞杀伤效果比较[J].海南医学院学报,2017,23(13):1841-1843.
[13]高莉莉,朱海峰,周九三,等.联合应用多西他赛、奥沙利铂和替吉奥新辅助化疗治疗进展期胃癌的疗效[J]江苏医药,2017,43(6):17-19.
[14]胡晓峰,武雪亮,杨东东,等.DOS方案新辅助化疗用于老年进展期胃上部癌手术患者效果观察[J].山东医药,2017,10(8):78-80.
[15]王蓉,王阳,王丹,等.DOS方案辅助化疗对进展期胃癌的临床效果分析[J].癌症进展,2017,12(6):673-675.
[16]宋敏,姜淮芜,李宗林,等.进展期胃癌血清CD4+T细胞、CD8+T细胞亚群检测的临床价值[J].中国医师杂志,2016,18(1):60-62.
[17]韩笑,麻树人,王大全,等.早期胃癌外周血细胞免疫功能状况变化研究[J].中国实用内科杂志,2015,(9):759-761.
[18]邵俊,陈颖,杨大明.进展期胃癌围手术期细胞免疫水平变化及临床意义[J].中国医药导刊,2012,14(1):88-89.
[19]瞿利帅,陈世耀.CD4+CD25+调节性T细胞对胃癌免疫调节的作用[J].现代消化及介入诊疗,2007,12(4):263-265.
[20]王大荣,罗红兰.原发性胃癌患者胃癌根治术后化疗对患者外周血T细胞亚群及NK细胞的影响及临床意义[J]临床和实验医学杂志,2016,15(9):871-873.
[2]葛清萌,戴少华,赵顺林.中上部进展期胃癌术后复发的危险因素分析[J].华南国防医学杂志,2018,10(2):97-100.
[3]杨娟,燕速.影响进展期胃癌新辅助化疗患者临床疗效的危险因素[J].实用癌症杂志,2017,32(5):770-772.
[4]中华人民共和国卫生部医政司.胃癌诊疗规范(2011版)[J].中国医学前沿杂志(电子版),2012,4(5):62-67.
[5]中华人民共和国国家卫生和计划生育委员会.胃癌规范化诊疗指南(试行)[J].中国医学前沿杂志(电子版),2013,4(8):56-63.
[6]季加孚,季鑫,步召德.从规范化到精准化:胃癌手术治疗的发展[J].中华外科杂志,2016,54(3):164-168.
[7]宋杰,陈凤格,赵伟,等.胃癌的发病率现状与治疗研究进展[J].中国慢性病预防与控制,2016,24(9):704-707.
[8]姚慰峰.新辅助化疗对进展期胃癌临床分期及肿瘤相关标记物的影响[J].贵州医药,2016,40(8):835-837.
[9]宋华勇,张帆,马磊.术前新辅助化疗对进展期胃癌手术清除率及并发症的影响[J].医学临床研究,2016,33(10):1943-1945.
[10]王鑫昊,李云龙.靶向药物在进展期胃癌中的研究进展[J].中国医药,2017,12(2):316-320.
[11]梁华,李春艳,张海梅,等.DOS方案新辅助化疗治疗局部晚期胃癌的疗效及安全性研究[J].癌症进展,2018,16(3):345-348.
[12]陈亚妮,胡海峰.DOS方案和SOX方案用于胃癌新辅助化疗的癌细胞杀伤效果比较[J].海南医学院学报,2017,23(13):1841-1843.
[13]高莉莉,朱海峰,周九三,等.联合应用多西他赛、奥沙利铂和替吉奥新辅助化疗治疗进展期胃癌的疗效[J]江苏医药,2017,43(6):17-19.
[14]胡晓峰,武雪亮,杨东东,等.DOS方案新辅助化疗用于老年进展期胃上部癌手术患者效果观察[J].山东医药,2017,10(8):78-80.
[15]王蓉,王阳,王丹,等.DOS方案辅助化疗对进展期胃癌的临床效果分析[J].癌症进展,2017,12(6):673-675.
[16]宋敏,姜淮芜,李宗林,等.进展期胃癌血清CD4+T细胞、CD8+T细胞亚群检测的临床价值[J].中国医师杂志,2016,18(1):60-62.
[17]韩笑,麻树人,王大全,等.早期胃癌外周血细胞免疫功能状况变化研究[J].中国实用内科杂志,2015,(9):759-761.
[18]邵俊,陈颖,杨大明.进展期胃癌围手术期细胞免疫水平变化及临床意义[J].中国医药导刊,2012,14(1):88-89.
[19]瞿利帅,陈世耀.CD4+CD25+调节性T细胞对胃癌免疫调节的作用[J].现代消化及介入诊疗,2007,12(4):263-265.
[20]王大荣,罗红兰.原发性胃癌患者胃癌根治术后化疗对患者外周血T细胞亚群及NK细胞的影响及临床意义[J]临床和实验医学杂志,2016,15(9):871-873.