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曲妥珠单抗辅助改良DOF双周方案对顺铂耐药的胃癌患者血清肿瘤标志物及生存率的影响分析
Analysis of effects of trastuzumab assisted modified DOF fortnightly regimen on serum tumor markers and survival rate in patients with cisplatin-resistant gastric cancer
- 中国癌症杂志 2024年34卷第3期 页码：286-292
- 作者机构：
哈励逊国际和平医院消化内科，河北 衡水 053000
- 作者简介：
[ "李晶（ORCID: 0009-0000-2369-4285），本科。" ]
郑磊（ORCID: 0009-0004-3660-2879），硕士。
- 基金信息：河北省卫生健康委医学科学研究项目(20210731)
DOI：10.19401/j.cnki.1007-3639.2024.03.006
中图分类号： R735.2收稿：2023-10-07，
修回：2024-02-22，
纸质出版：2024-03-30
- 稿件说明：
移动端阅览
李晶, 郑磊, 高钰. 曲妥珠单抗辅助改良DOF双周方案对顺铂耐药的胃癌患者血清肿瘤标志物及生存率的影响分析[J]. 中国癌症杂志, 2024,34(3):286-292.
Jing LI, Lei ZHENG, Yu GAO. Analysis of effects of trastuzumab assisted modified DOF fortnightly regimen on serum tumor markers and survival rate in patients with cisplatin-resistant gastric cancer[J]. China Oncology, 2024, 34(3): 286-292.
李晶, 郑磊, 高钰. 曲妥珠单抗辅助改良DOF双周方案对顺铂耐药的胃癌患者血清肿瘤标志物及生存率的影响分析[J]. 中国癌症杂志, 2024,34(3):286-292. DOI： 10.19401/j.cnki.1007-3639.2024.03.006.
Jing LI, Lei ZHENG, Yu GAO. Analysis of effects of trastuzumab assisted modified DOF fortnightly regimen on serum tumor markers and survival rate in patients with cisplatin-resistant gastric cancer[J]. China Oncology, 2024, 34(3): 286-292. DOI： 10.19401/j.cnki.1007-3639.2024.03.006.
摘要
背景与目的：
曲妥珠单抗的耐药发生率相对较低，可以作为辅助治疗提高临床疗效，既往多用于治疗乳腺癌，在其他癌症中的应用研究较少。本研究旨在探讨曲妥珠单抗辅助改良DOF双周方案对顺铂耐药的胃癌患者血清肿瘤标志物和生存率的影响，以期为顺铂耐药的胃癌患者的临床治疗方式选择提供更多参考。
方法：
选择2017年1月—2019年1月哈励逊国际和平医院收治的80例顺铂耐药的胃癌患者作为研究对象，按随机数字表法均分为观察组和对照组，均接受改良DOF双周方案治疗，观察组在此基础上加上曲妥珠单抗辅助治疗。比较两组的血清肿瘤标志物[血清癌胚抗原（carcinoembryonic antigen，CEA）、糖类抗原19-9（carbohydrate antigen 19-9，CA19-9）、CA72-4
]
、血清新生血管标志物[血管内皮生长因子（vascular endothelial growth factor，VEGF）、色素上皮衍生因子（pigment epithelial derived factor，PEDF）、血管生成素-2（angiopoietin-2，Ang-2）
]
、生化指标[N端脑钠肽前体（N terminal pro B type natriuretic peptide，NT-proBNP）、天冬氨酸转氨酶（aspartate transaminase，AST）、血尿素氮（blood urea nitrogen，BUN）、丙氨酸转氨酶（Alanine aminotransferase，ALT）
]
、不良反应及生存率。本研究经哈励逊国际和平医院伦理委员会审查批准（编号：20160511）。
结果：
治疗后，两组的
CEA、CA19-9及CA72-4较治疗前下降，且观察组的CEA、CA19-9及CA72-4检测值均低于对照组，差异有统计学意义（
P
<
0.01）。治疗后，两组的VEGF、PEDF及Ang-2较治疗前下降，差异有统计学意义（
P
<
0.01）；两组治疗前后的VEGF、PEDF及Ang-2差异无统计学意义（
P
>
0.05）。两组治疗前后的NT-proBNP、AST、BUN及ALT差异无统计学意义（
P
>
0.05）。两组的乏力、胃肠道反应、骨髓抑制发生人数占比及不良反应总发生率差异无统计学意义（
P
>
0.05）。治疗后5年，观察组存活11例（27.5%），死亡29例（72.5%）；对照组存活3例（7.5%），死亡37例（92.5%），观察组的中位生存期为2年（95% CI：1.8 ~ 2.2），对照组的中位生存期为1年（95% CI：0.6 ~ 1.4），观察组1 ~ 5年存活率高于对照组，差异有统计学意义（log-rank
χ
2
= 13.853，
P
= 0.001）。
结论：
在顺铂耐药胃癌患者的临床治疗中采用曲妥珠单抗辅助改良DOF双周方案能降低血清肿瘤标志物表达水平，提升患者的5年生存率，且用药安全性较高。
Abstract
Background and purpose:
Trastuzumab has a relatively low incidence of drug resistance
which can be used as an adjuvant treatment to improve clinical efficacy. It has been used to treat breast cancer in the past
but its application in other cancers has been less studied. This study aimed to explore the effects of trastuzumab assisted modified DOF fortnightly regimen on serum tumor markers and survival rate in cisplatin-resistant gastric cancer patients
in order to provide more references for the selection of clinical treatment methods for cisplatin-resistant gastric cancer.
Methods:
Eighty patients with cisplatin-resistant gastric cancer treated in Harison International Peace Hospital from January 2017 to January 2019 were selected as the study objects
and they were divided into observation group and control group according to random number table method. All of them received improved DOF fortnightly treatment
and trastuzumab adjuvant treatment was added to the observation group on this basis. The serum tumor markers [serum carcinoembryonic antigen (CEA)
carbohydrate antigen 19-9 (CA19-9)
CA72-4
]
serum neovascular markers [vascular endothelial growth factor (VEGF)
pigment epithelial derived factor (PEDF)
angiopoietin-2 (Ang-2)
]
biochemical i
ndicators [N-terminal pro B type natriuretic peptide (NT proBNP)
aspartate transaminase (AST)
blood urea nitrogen (BUN)
alanine aminotransferase (ALT)
]
adverse reactions and survival rate were compared between two groups. This study was approved by the Ethics Committee of Harison International Peace Hospital (number: 20160511).
Results:
After treatment
CEA
CA19-9 and CA72-4 in both groups decreased
and CEA
CA19-9 and CA72-4 levels were lower in the observation group than in the control group with statistical significance (
P
<
0.01). After treatment
VEGF
PEDF and Ang-2 in two groups decreased
and the difference was statistically significant (
P
<
0.01). The levels of VEGF
PEDF and Ang-2 were compared between the two groups before and after treatment
and there was no significant difference (
P
>
0.05). The levels of NT-proBNP
AST
BUN and ALT were compared between the two groups before and after treatment
and there was no statistically significant difference (
P
>
0.05). The number of patients with fatigue
gastrointestinal reaction and myelosuppression and the total incidence of adverse reactions were compared between the two groups
and there was no statistically significant difference (
P
>
0.05). At 5 years after treatment
11 cases (27.5%) survived and 29 cases (72.5%) died in the observation group. There were 3 cases (7.5%) of survival and 37 cases (92.5%) of death in the control group. The median survival was 2 years (95% CI: 1.8-2.2) in the observation group and 1 year (95% CI: 0.6-1.4) in the control group. The survival rate of 1-5 years was higher in the observation group than in the control group. The difference was statistically significant (log-rank
χ
2
= 13.853
P
= 0.001).
Conclusion:
In the clinical treatment of cisplatin-resistant gastric cancer
trastuzumab assisted modified DOF fortnightly regimen suggests that it can reduce the
expression levels of serum tumor markers
improve the 5-year survival rate of patients
and has certain drug safety.
关键词
Keywords
references
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