GEMOX方案联合靶向药物治疗晚期胆囊癌的临床疗效  

Clinical efficacy of GEMOX regimen combined with targeted therapy for advanced gallbladder cancer

作　　者：包润发[1] 吕文杰[1] 李茂岚[1] 龚伟[1] 刘颖斌[1] Bao Runfa;Lyu Wenjie;Li Maolan;Gong Wei;Liu Yingbin(Department of General Surgery,Xinhua Hospital,Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院普通外科,200092

出　　处：《中华消化外科杂志》2019年第2期140-145,共6页Chinese Journal of Digestive Surgery

基　　金：上海交通大学医学院多中心临床研究项目(DLY201507);上海交通大学医学院高峰高原计划(20181808).

摘　　要：目的评价GEMOX(吉西他滨+奥沙利铂)方案联合靶向药物治疗晚期胆囊癌的临床疗效.方法采用回顾性描述性研究方法.收集2016年1月至2017年12月上海交通大学医学院附属新华医院收治的21例晚期胆囊癌患者的临床资料;男8例,女13例;年龄为(58±12)岁,年龄范围为28~80岁.患者行GEMOX方案联合靶向药物治疗,根据基因检测结果选取西妥昔单克隆抗体、曲妥珠单克隆抗体和阿帕替尼靶向药物治疗.观察指标:(1)基因检测情况.(2)GEMOX方案联合靶向药物治疗情况.(3)GEMOX方案联合靶向药物治疗的不良反应情况.正态分布的计量资料以Mean±SD表示,偏态分布的计量资料以M(范围)表示.计数资料以绝对数或百分比表示.采用Kaplan-Meier法绘制生存曲线并计算生存率,采用Log-rank检验进行生存分析.结果(1)基因检测情况:21例患者中,K-ras野生型19例[单纯K-ras野生型13例、K-ras野生型合并人类表皮生长因子受体2(HER2)阳性4例、合并血管内皮生长因子受体2(VEGFR2)阳性2例],HER2阳性5例(单纯HER2阳性1例、HER2阳性合并K-ras野生型4例),VEGFR2阳性3例(单纯VEGFR2阳性1例、VEGFR2阳性合并K-ras野生型2例).美国东部肿瘤协作组(ECOG)评分为0分2例,评分为1分19例.(2)GEMOX方案联合靶向药物治疗情况:21例患者均完成≥2个疗程的GEMOX方案联合靶向药物治疗,其完全缓解(CR)、部分缓解(PR)、疾病稳定(SD)、疾病进展(PD)分别为O、4、9、8例.14例(单纯K-ras野生型13例、K-ras野生型合并VEGFR2阳性1例)患者GEMOX方案联合西妥昔单克隆抗体治疗,其CR、PR、SD、PD分别为0、4、5、5例;5例(单纯HER2阳性1例、HER2阳性合并K-ras野生型4例)联合曲妥珠单克隆抗体治疗,其CR、PR、SD、PD分别为0、0、2、3例;2例(单纯VEGFR2阳性1例、合并K-ras野生型1例)联合阿帕替尼治疗,其CR、PR、SD、PD分别为0、0、2、0例.21例患者客观有效率为19.0%(4/21),疾病控制率为61.9%(13/21).21�Objective To evaluate the clinical efficacy of gemcitabine-oxaliplatin (GEMOX)regimen combined with targeted therapy for advanced gallbladder cancer.Methods The retrospective descriptive study was conducted.The clinical data of 21 patients with advanced gallbladder cancer who were admitted to the Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine between January 2016 and December 2017were collected,including 8 males and 13 females,aged from 28 to 80 years,with the age of (58_+12)years. Patients received GEMOX regimen combined with targeted therapy.According to the results of gene test,patients selected tageted therapy with Cetuximab,Hereeptin or Apatinib.Observation indicators :(1)gene test situations;(2)situations of GEMOX regimen combined with targeted therapy;(3)adverse reactions of GEMOX regimen combined with targeted therapy.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were described as M (range).Count data were represented as absolute number or percentage.The survival curve and rate were respectively drawn and calculated using the Kaplan-Meier method.The survival analysis was done using the Log-rank test.Results (1)Gene test situations:of 21 patients,19 were confirmed as K-ras wild type,including 13 of single K-ras wild type,4 of K-ras wild type combined with human epidermal growth factor receptor 2 (HER2),2 of K-ras wild type combined with vascular endothelial growth factor receptor 2 (VEGFR2);5 were detected positive HER2,including 1 of single positive HER2,4 of positive HER2 combined with K-ras wild type;3 were detected positive VEGFR2,including 1 of single positive VEGFR2,2 of positive VEGFR2 combined with K-ras wild type.Two and 19 patients had 0 and 1 of Eastern Cooperative Ontology Group score.(2)Situations of GEMOX regimen combined with targeted therapy: all the 21 patients underwent I>2 courses of GEMOX regimen combined with targeted therapy.Among the 21 patients,0,4,9 and 8 were respectively detected

关 键 词：胆道肿瘤 胆囊癌 化疗 靶向药物治疗 疗效 安全性 

分 类 号：R735.8[医药卫生—肿瘤]