肝动脉灌注化疗联合XELOX方案在胃肠道恶性肿瘤肝转移病人中的效果观察
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摘要
目的研究并探讨肝动脉灌注化疗联合XELOX方案在胃肠道恶性肿瘤肝转移病人中的应用效果。方法选取2012年6月至2014年1月经云南省第三人民医院治疗且随访3年成功的60例胃肠道恶性肿瘤肝转移病人作为研究对象,采取计算机单盲随机分组法将病人随机分为两组,对照组30例病人接受经全身静脉姑息性化疗,观察组30例病人接受经肝动脉灌注化疗联合XELOX方案治疗,比较两组近期疗效、中远期疗效、毒副反应发生率、肝功能指标以及生存质量评分。结果近期疗效方面,观察组的近期总有效率70.00%高于对照组的43.33%(χ~2=4.344,P=0.037);中远期疗效方面,观察组的1年生存率(76.67%)高于对照组的50.00%(χ~2=4.593,P=0.032),而其2年生存率、3年生存率与对照组的23.33%、16.67%比较差异无统计学意义(χ~2=1.270、0.577,P=0.260、0.448);治疗后,观察组的血清γ-谷氨酰转移酶(27.53±9.24)U/L、碱性磷酸酶(69.87±27.34)U/L均低于对照组的(41.76±14.37)、(113.45±48.63) U/L(t=4.562、4.279,均P=0.000);毒副反应方面,观察组的恶心呕吐发生率(33.33%)、腹泻发生率(26.67%)、口腔炎发生率(30.00%)、脱发发生率(23.33%)均低于对照组的60.00%、53.33%、60.00%、56.67%(χ~2=4.286、4.444、5.455、6.944,P=0.038、0.035、0.020、0.008);生存质量方面,观察组的躯体健康评分(76.47±5.69)分、心理健康评分(79.14±6.43)分、社会功能评分(79.81±6.65)分、物质生活评分(84.52±7.67)分均高于对照组的(63.58±5.53)、(69.72±5.83)、(64.23±6.31)、(73.81±6.92)分(t=8.898、5.945、9.309、5.679,均P=0.000)。结论在胃肠道恶性肿瘤肝转移病人中应用经肝动脉灌注化疗联合XELOX方案,可有效提高病人的近期疗效,延缓其肿瘤进展,尽可能提高病人的存活率,有效改善病人存活期内的生存质量,还可有效减少毒副反应,其对病人肝功能指标的不良影响相对较轻。
Objective To study and explore the application of the hepatic artery infusion chemotherapy combined with XELOX regimen in patients with hepatic metastasis of gastrointestinal malignant tumors.Methods Sixty cases of patients with hepatic metastasis of gastrointestinal malignant tumors,who were treated in The Third People's Hospital from June 2012 to January 2014 and had been followed up for 3 years,were selected for the study.The patients were randomly assigned into two groups by computers with single-blind method:the control group(30 cases) received systematic venous palliative chemotherapy,while the observation group(30 cases) received hepatic arterial infusion chemotherapy combined XELOX scheme.A comparison was made between the groups of short-term efficacy,medium-long-term efficacy,adverse reactions,liver function index and quality of life.Results In terms of short-term efficacy,the overall short-term effective rate in the observation group was 70.00%,higher than 43.33% of the control group(χ~2=4.344,P=0.037).In terms of medium-long-term efficacy,1-year survival rate(76.67%) in the observation group was higher than 50.00% in the control group(χ~2=4.593,P=0.032),and 2-year survival rate and 3-year survival rate had no statistically significant difference from 23.33% and 16.67% in the control group(χ~2=1.270,0.577,P=0.260,0.448).After treatment,Gamma-glutamyl transferase [(27.53±9.24) U/L] and alkaline phosphatase [(69.87±27.34) U/L] in the observation group were lower than those in the control group [(41.76±14.37) U/L,(113.45±48.63) U/L,respectively](t=4.562,4.279,all P=0.000).In terms of adverse reactions,the incidences of nausea and vomiting(33.33%),diarrhea(26.67%),stomatitis(30.00%),and hair loss(23.33%) in the observation group were lower than those in the control group(60.00%,53.33%,60.00%,and 56.67%,respectively)(χ~2=4.286,4.444,5.455,6.944,P=0.038\,0.035、0.020、0.008).In terms of quality of life,the physical health score(76.47±5.69) points,mental health score(79.14±6.43) points,social function score(79.81±6.65 points),material life score(84.52±7.67) points of the observation group were all higher than those of the control group [(63.58±5.53) points,(69.72±5.83) points,(64.23±6.31) points,(73.81±6.92) points,respectively](t=8.898,5.945,9.309,5.679,all P=0.000).Conclusions Hepatic arterial infusion chemotherapy combined with XELOX regimen in patients with hepatic metastasis of gastrointestinal malignant tumors can effectively improve the short-term curative effect,delay tumor progression and improve the survival rate of patients as much as possible.It can effectively improve the quality of life and reduce the side effects of the patients,and the adverse effects on the liver function index are relatively slight.
Objective To study and explore the application of the hepatic artery infusion chemotherapy combined with XELOX regimen in patients with hepatic metastasis of gastrointestinal malignant tumors.Methods Sixty cases of patients with hepatic metastasis of gastrointestinal malignant tumors,who were treated in The Third People's Hospital from June 2012 to January 2014 and had been followed up for 3 years,were selected for the study.The patients were randomly assigned into two groups by computers with single-blind method:the control group(30 cases) received systematic venous palliative chemotherapy,while the observation group(30 cases) received hepatic arterial infusion chemotherapy combined XELOX scheme.A comparison was made between the groups of short-term efficacy,medium-long-term efficacy,adverse reactions,liver function index and quality of life.Results In terms of short-term efficacy,the overall short-term effective rate in the observation group was 70.00%,higher than 43.33% of the control group(χ~2=4.344,P=0.037).In terms of medium-long-term efficacy,1-year survival rate(76.67%) in the observation group was higher than 50.00% in the control group(χ~2=4.593,P=0.032),and 2-year survival rate and 3-year survival rate had no statistically significant difference from 23.33% and 16.67% in the control group(χ~2=1.270,0.577,P=0.260,0.448).After treatment,Gamma-glutamyl transferase [(27.53±9.24) U/L] and alkaline phosphatase [(69.87±27.34) U/L] in the observation group were lower than those in the control group [(41.76±14.37) U/L,(113.45±48.63) U/L,respectively](t=4.562,4.279,all P=0.000).In terms of adverse reactions,the incidences of nausea and vomiting(33.33%),diarrhea(26.67%),stomatitis(30.00%),and hair loss(23.33%) in the observation group were lower than those in the control group(60.00%,53.33%,60.00%,and 56.67%,respectively)(χ~2=4.286,4.444,5.455,6.944,P=0.038\,0.035、0.020、0.008).In terms of quality of life,the physical health score(76.47±5.69) points,mental health score(79.14±6.43) points,social function score(79.81±6.65 points),material life score(84.52±7.67) points of the observation group were all higher than those of the control group [(63.58±5.53) points,(69.72±5.83) points,(64.23±6.31) points,(73.81±6.92) points,respectively](t=8.898,5.945,9.309,5.679,all P=0.000).Conclusions Hepatic arterial infusion chemotherapy combined with XELOX regimen in patients with hepatic metastasis of gastrointestinal malignant tumors can effectively improve the short-term curative effect,delay tumor progression and improve the survival rate of patients as much as possible.It can effectively improve the quality of life and reduce the side effects of the patients,and the adverse effects on the liver function index are relatively slight.
引文
[1] 李毅,卿毅,廖正银,等.肝动脉置管持续灌注化疗和栓塞联合全身静脉化疗治疗结直肠癌肝转移的疗效观察[J].重庆医学,2012,41(29):3046-3048.
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[3] 周辉,吴缨,牟洪超,等.经门静脉和肝动脉灌注化疗治疗不可切除的结直肠癌肝转移的临床研究[J].肿瘤学杂志,2015,21(1):51-55.
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[5] 郑琳,黎海亮,郭晨阳,等.FOLFOX方案肝动脉化疗栓塞并留管灌注联合替吉奥治疗胃癌术后肝转移的临床疗效评价[J].疑难病杂志,2013,12(2):117-119.
[6] 李慧,江旭,杨朝爱,等.改良XELOX方案治疗胃肠道腺癌伴肝转移的临床研究[J].中国医药导报,2014,11(30):37-41.
[7] 卢桂龙,任庆云.肝动脉化疗栓塞术与化疗灌注术治疗肝转移癌的疗效比较[J].医学临床研究,2015,32(9):1668-1670,1673.
[8] RIBEIRO HS,COSTA WL JR,DINIZ AL,et al.Extended preoperative chemotherapy,extent of liver resection and blood transfusion are predictive factors of liver failure following resection of colorectal liver metastasis[J].Eur J Surg Oncol,2013,39(4):380-385.
[9] HSU HC,CHOU WC,SHEN WC,et al.Efficacy of postoperative oxaliplatin-or irinotecan-based chemotherapy after curative resection of synchronous liver metastases from colorectal cancer[J].Anticancer Res,2013,33(8):3317-3325.
[10] 肖宇,马力文,曹宝山,等.肝动脉灌注化疗联合XELOX方案治疗胃肠道恶性肿瘤肝转移的疗效及安全性分析[J].中国微创外科杂志,2016,16(1):5-8.
[11] 李慧,江旭,杨朝爱,等.改良 XELOX 方案治疗结直肠癌伴肝转移的临床研究[J].实用放射学杂志,2015,30(9):1506-1510.
[12] 王韵,李宇红.肝动脉灌注在结直肠癌肝转移治疗中的应用现状及前景[J].中国肿瘤临床,2015,42(20):997-1001.
[13] 唐仪,杨厚林,吴少杰,等.肝动脉置管化疗栓塞在不可切除结肠癌肝转移的临床疗效评价[J].中华临床医师杂志(电子版),2014,8(3):426-429.DOI:10.3877/cma.j.issn.1674-0785.2014.03.015.
[14] 李慧.改良XELOX方案治疗胃癌、结直肠癌肝转移的临床研究[D].上海:第二军医大学,2014.
[15] 李慧,江旭,杨继金,等.改良XELOX方案治疗胃癌伴肝转移[J].西部医学,2016,28(4):520-523.
[16] 关宇,刘占兵,汪欣,等.136例H1、H2级胃癌肝转移患者的预后影响因素分析[J].解放军医学杂志,2016,41(4):312-316.
[17] 冉文华,王子卫.结直肠癌肝转移转化治疗研究进展[J].重庆医学,2013,42(9):1069-1072.
[18] 张晓前,苑天文.洛铂与顺铂联合氟尿嘧啶在胃肠道肿瘤肝转移介入治疗中的比较分析[J].中国药物与临床,2016,16(6):902-905.
[19] 解华,刘宏杰,李凌云,等.全身化疗联合肝动脉栓塞灌注化疗治疗乳腺癌肝转移的效果[J].蚌埠医学院学报,2016,41(11):1474-1477.
[20] 马友龙,郑海燕,祁海艳.多西紫杉醇联合方案经动脉介入治疗结直肠癌肝转移的临床研究[J].中国现代医学杂志,2015,25(33):65-70.
[21] 刘凯,夏进东,金川连,等.射频消融术对转移性肝癌的近期疗效价值研究[J].河北医学,2016,22(10):1674-1676.
[22] 邢宝才,徐达.结直肠癌肝转移的临床研究进展[J].中华肿瘤杂志,2015,37(9):659-663.
[2] 江露,石亮荣,赵洁敏,等.经肝动脉药盒持续灌注氟脲苷与地塞米松治疗化疗抵抗的结直肠癌肝转移的疗效与安全性分析[J].中华临床医师杂志(电子版),2014,8(2):211-215.DOI:10.3877/cma.j.issn.1674-0785.2014.02.009.
[3] 周辉,吴缨,牟洪超,等.经门静脉和肝动脉灌注化疗治疗不可切除的结直肠癌肝转移的临床研究[J].肿瘤学杂志,2015,21(1):51-55.
[4] WANG YY,ZHANG W,QIAN S,et al.The effect of locoregional transarterial infusion chemotherapy on liver metastasis after gastric cancer resection[J].J Int Med Res,2012,40(3):1141-1148.
[5] 郑琳,黎海亮,郭晨阳,等.FOLFOX方案肝动脉化疗栓塞并留管灌注联合替吉奥治疗胃癌术后肝转移的临床疗效评价[J].疑难病杂志,2013,12(2):117-119.
[6] 李慧,江旭,杨朝爱,等.改良XELOX方案治疗胃肠道腺癌伴肝转移的临床研究[J].中国医药导报,2014,11(30):37-41.
[7] 卢桂龙,任庆云.肝动脉化疗栓塞术与化疗灌注术治疗肝转移癌的疗效比较[J].医学临床研究,2015,32(9):1668-1670,1673.
[8] RIBEIRO HS,COSTA WL JR,DINIZ AL,et al.Extended preoperative chemotherapy,extent of liver resection and blood transfusion are predictive factors of liver failure following resection of colorectal liver metastasis[J].Eur J Surg Oncol,2013,39(4):380-385.
[9] HSU HC,CHOU WC,SHEN WC,et al.Efficacy of postoperative oxaliplatin-or irinotecan-based chemotherapy after curative resection of synchronous liver metastases from colorectal cancer[J].Anticancer Res,2013,33(8):3317-3325.
[10] 肖宇,马力文,曹宝山,等.肝动脉灌注化疗联合XELOX方案治疗胃肠道恶性肿瘤肝转移的疗效及安全性分析[J].中国微创外科杂志,2016,16(1):5-8.
[11] 李慧,江旭,杨朝爱,等.改良 XELOX 方案治疗结直肠癌伴肝转移的临床研究[J].实用放射学杂志,2015,30(9):1506-1510.
[12] 王韵,李宇红.肝动脉灌注在结直肠癌肝转移治疗中的应用现状及前景[J].中国肿瘤临床,2015,42(20):997-1001.
[13] 唐仪,杨厚林,吴少杰,等.肝动脉置管化疗栓塞在不可切除结肠癌肝转移的临床疗效评价[J].中华临床医师杂志(电子版),2014,8(3):426-429.DOI:10.3877/cma.j.issn.1674-0785.2014.03.015.
[14] 李慧.改良XELOX方案治疗胃癌、结直肠癌肝转移的临床研究[D].上海:第二军医大学,2014.
[15] 李慧,江旭,杨继金,等.改良XELOX方案治疗胃癌伴肝转移[J].西部医学,2016,28(4):520-523.
[16] 关宇,刘占兵,汪欣,等.136例H1、H2级胃癌肝转移患者的预后影响因素分析[J].解放军医学杂志,2016,41(4):312-316.
[17] 冉文华,王子卫.结直肠癌肝转移转化治疗研究进展[J].重庆医学,2013,42(9):1069-1072.
[18] 张晓前,苑天文.洛铂与顺铂联合氟尿嘧啶在胃肠道肿瘤肝转移介入治疗中的比较分析[J].中国药物与临床,2016,16(6):902-905.
[19] 解华,刘宏杰,李凌云,等.全身化疗联合肝动脉栓塞灌注化疗治疗乳腺癌肝转移的效果[J].蚌埠医学院学报,2016,41(11):1474-1477.
[20] 马友龙,郑海燕,祁海艳.多西紫杉醇联合方案经动脉介入治疗结直肠癌肝转移的临床研究[J].中国现代医学杂志,2015,25(33):65-70.
[21] 刘凯,夏进东,金川连,等.射频消融术对转移性肝癌的近期疗效价值研究[J].河北医学,2016,22(10):1674-1676.
[22] 邢宝才,徐达.结直肠癌肝转移的临床研究进展[J].中华肿瘤杂志,2015,37(9):659-663.