贝伐单抗联合化疗治疗Ⅳ期左、右半结肠癌临床疗效观察
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摘要
目的观察贝伐单抗联合化疗治疗Ⅳ期左右半结肠癌临床疗效。方法对我院2012年1月～2017年1月收治的57例经贝伐单抗联合化疗治疗的Ⅳ期左右半结肠癌患者进行回顾性分析,比较左、右半结肠癌患者的临床特征、临床受益率(CBR)、无进展生存时间(PFS)及总生存时间(OS)。结果Ⅳ期右半结肠癌(RSCC)患者中高龄及女性患者更常见,更易合并体重下降(P=0.041)及贫血(P=0.639),且出现CEA(P=0.038)及CA199(P=0.027)异常升高的患者所占比例更高,而左半结肠癌(LSCRC)患者中合并肠梗阻的比例更高(P=0.882)。腹腔种植转移及多脏器转移患者所占比例RSCC高于LSCRC(P=0.426,P=0.579)。RSCC与LSCRC患者CBR分别为70.00%和96.30%,差异有统计学意义(P=0.024);LSCRC患者中位PFS和OS均优于RSCC患者(10个月vs 5个月,P=0.035;25个月vs 21个月,P=0.001)。结论贝伐单抗联合化疗治疗Ⅳ期左右半结肠癌临床疗效较好,但右半结肠癌患者预后差于左半结肠癌患者。
Objective To observe the clinical efficacy of bevacizumab combined with chemotherapy in the treatment of stage IV colon cancer.Methods A retrospective analysis of 57 patients with stage IV colon cancer who were treated with bevacizumab and chemotherapy in our hospital from January 2012 to January 2017 was performed to compare the clinical features of patients with left and right colon cancer. Clinical benefit rate(CBR), progression-free survival(PFS), and overall survival(OS). Results Patients with advanced stage IV colon cancer(RSCC) were more common in older patients(P=0.038) and females(P=0.653), and were more likely to have weight loss(P=0.041) and anemia(P=0.639),Patients with abnormally elevated CEA(P=0.038) and CA199(P=0.027) had a higher proportion, while patients with left colon cancer(LSCRC) had a higher proportion of intestinal obstruction(P=0.882).The percentage of RSCC in patients with peritoneal implant metastasis and multiple organ metastasis was higher than that in LSCRC(P =0.426, P =0.579).The CBR of patients with RSCC and LSCRC were 70.00% and 96.30%, respectively, and the difference was statistically significant(P=0.024). The median PFS and OS of patients with LSCRC were better than those of RSCC(10 months vs. 5 months, P=0.035;25 months vs. 21 months, P=0.001). Conclusion Bevacizumab combined with chemotherapy for the treatment of stage IV colon cancer is better, but the prognosis of patients with right colon cancer is worse than that of patients with left colon cancer.
Objective To observe the clinical efficacy of bevacizumab combined with chemotherapy in the treatment of stage IV colon cancer.Methods A retrospective analysis of 57 patients with stage IV colon cancer who were treated with bevacizumab and chemotherapy in our hospital from January 2012 to January 2017 was performed to compare the clinical features of patients with left and right colon cancer. Clinical benefit rate(CBR), progression-free survival(PFS), and overall survival(OS). Results Patients with advanced stage IV colon cancer(RSCC) were more common in older patients(P=0.038) and females(P=0.653), and were more likely to have weight loss(P=0.041) and anemia(P=0.639),Patients with abnormally elevated CEA(P=0.038) and CA199(P=0.027) had a higher proportion, while patients with left colon cancer(LSCRC) had a higher proportion of intestinal obstruction(P=0.882).The percentage of RSCC in patients with peritoneal implant metastasis and multiple organ metastasis was higher than that in LSCRC(P =0.426, P =0.579).The CBR of patients with RSCC and LSCRC were 70.00% and 96.30%, respectively, and the difference was statistically significant(P=0.024). The median PFS and OS of patients with LSCRC were better than those of RSCC(10 months vs. 5 months, P=0.035;25 months vs. 21 months, P=0.001). Conclusion Bevacizumab combined with chemotherapy for the treatment of stage IV colon cancer is better, but the prognosis of patients with right colon cancer is worse than that of patients with left colon cancer.
引文
[1]Warschkow R,Sulz MC,Marti L,et al.Better survival in rightsided versus left-sided stageⅠ~Ⅲcolon cancer patients[J].BMC Cancer,2016(16):554.
[2]Yin C,Jiang C,Liao F,et al.Initial LDH level can predict the survival benefit from bevacizumab in the first-line setting in Chinese patients with metastatic colorectal cancer[J].Oncol Targets Ther,2014(7):1415-1422.
[3]Therasse P,Arbuck SG,Eisenhauer EA,et al.New guidelines to evaluate the response to treatment in solid tumors[J].JNCI,2000(92):205-216.
[4]Park JH,van Wyk H,Roxburgh CSD,et al.Tumour invasiveness, the local and systemic environment and the basis of staging systems in colorectal cancer[J].Br J Cancer,2017,116(11):1444-1450.
[5]Tauriello DV,Calon A,Lonardo E,et al.Determinants of metastatic competency in colorectal cancer[J].Mol Oncol,2017,11(1):97-119.
[6]Bufill JA.Colorectal cancer:evidence for distinct genetic categories based on proximal or distal tumor location[J].Ann Intern Med,1990(113):779-788.
[7]Kashfi MH,Mojarad EN,Pourhoseingholi MA,et al.Evaluation of the left-to-right shift of colon tumors in Iran:Is the trend changing?[J].J Res Med Sci,2015,20(10):978-986.
[8]von Einem JC,Heinemann V,von Weikersthal LF,et al.Leftsided primary tumors are associated with favorable prognosis in patients with KRAS codon 12/13 wild-type metastatic colorectal cancer treated with cetuximab plus chemotherapy:an analysis of the AIO KRK-0104 trial[J].J Cancer Res Clin Oncol,2014(140):1607-1614.
[9]Jemal A,Siegel R,Xu J,et al.Cancer statistics,2013[J].CA Cancer J Clin,2013(63):11-30.
[10]Lochhead P,Chan AT,Giovannucci E,et al.Progress and Opportunities in Molecular Pathological Epidemiology of Colorectal Premalignant Lesions[J].Am J Gastroenterol,2014,109(8):1205-1214.
[11]Okugawa Y,Grady WM,Goel A.Epigenetic Alterations in Colorectal Cancer:Emerging Biomarkers[J].Gastroenterology,2015,149(5):1204-1225.
[12]Price TJ,Beeke C,Ullah S,et al.Does the primary site of colorectal cancer impact outcomes for patients with metastatic disease?[J].Cancer,2015,121(6):830-835.
[13]Bae JM,Kim JH,Cho NY,et al.Prognostic implication of the CpG island methylator phenotype in colorectal cancers depends on tumour location[J].Br J Cancer,2013,109(4):1004-1012.
[14]Ishihara S,Nishikawa T,Tanaka T,et al.Prognostic impact of tumor location in stageⅣcolon cancer:a propensity score analysis in a multicenter study[J].Int J Surg,2014,12(9):925-930.
[15]Boise MK,Johansen IS,Dehlendorff G,et al.Primary tumor location and bevacizumab effectiveness in patients with metastatic colorectal cancer[J].Annals of Oncology,2013(24):2554-2559.
[16]Loupakis F,Yang D,Yau L,et al.Primary Tumor Location as a Prognostic Factor in Metastatic Colorectal Cancer[J].J Natl Cancer Inst,2015,107(3):dju427.
[2]Yin C,Jiang C,Liao F,et al.Initial LDH level can predict the survival benefit from bevacizumab in the first-line setting in Chinese patients with metastatic colorectal cancer[J].Oncol Targets Ther,2014(7):1415-1422.
[3]Therasse P,Arbuck SG,Eisenhauer EA,et al.New guidelines to evaluate the response to treatment in solid tumors[J].JNCI,2000(92):205-216.
[4]Park JH,van Wyk H,Roxburgh CSD,et al.Tumour invasiveness, the local and systemic environment and the basis of staging systems in colorectal cancer[J].Br J Cancer,2017,116(11):1444-1450.
[5]Tauriello DV,Calon A,Lonardo E,et al.Determinants of metastatic competency in colorectal cancer[J].Mol Oncol,2017,11(1):97-119.
[6]Bufill JA.Colorectal cancer:evidence for distinct genetic categories based on proximal or distal tumor location[J].Ann Intern Med,1990(113):779-788.
[7]Kashfi MH,Mojarad EN,Pourhoseingholi MA,et al.Evaluation of the left-to-right shift of colon tumors in Iran:Is the trend changing?[J].J Res Med Sci,2015,20(10):978-986.
[8]von Einem JC,Heinemann V,von Weikersthal LF,et al.Leftsided primary tumors are associated with favorable prognosis in patients with KRAS codon 12/13 wild-type metastatic colorectal cancer treated with cetuximab plus chemotherapy:an analysis of the AIO KRK-0104 trial[J].J Cancer Res Clin Oncol,2014(140):1607-1614.
[9]Jemal A,Siegel R,Xu J,et al.Cancer statistics,2013[J].CA Cancer J Clin,2013(63):11-30.
[10]Lochhead P,Chan AT,Giovannucci E,et al.Progress and Opportunities in Molecular Pathological Epidemiology of Colorectal Premalignant Lesions[J].Am J Gastroenterol,2014,109(8):1205-1214.
[11]Okugawa Y,Grady WM,Goel A.Epigenetic Alterations in Colorectal Cancer:Emerging Biomarkers[J].Gastroenterology,2015,149(5):1204-1225.
[12]Price TJ,Beeke C,Ullah S,et al.Does the primary site of colorectal cancer impact outcomes for patients with metastatic disease?[J].Cancer,2015,121(6):830-835.
[13]Bae JM,Kim JH,Cho NY,et al.Prognostic implication of the CpG island methylator phenotype in colorectal cancers depends on tumour location[J].Br J Cancer,2013,109(4):1004-1012.
[14]Ishihara S,Nishikawa T,Tanaka T,et al.Prognostic impact of tumor location in stageⅣcolon cancer:a propensity score analysis in a multicenter study[J].Int J Surg,2014,12(9):925-930.
[15]Boise MK,Johansen IS,Dehlendorff G,et al.Primary tumor location and bevacizumab effectiveness in patients with metastatic colorectal cancer[J].Annals of Oncology,2013(24):2554-2559.
[16]Loupakis F,Yang D,Yau L,et al.Primary Tumor Location as a Prognostic Factor in Metastatic Colorectal Cancer[J].J Natl Cancer Inst,2015,107(3):dju427.