阿帕替尼联合替雷利珠单抗治疗一线化疗失败的晚期胃癌患者疗效分析  

Analysis of the therapeutic effect of apatinib combined with tirelizumab in the treatment of advanced gastric cancer patients who failed first-line chemotherapy

作　　者：张媛媛 刘雪利 张蕾[2] 张晓光 成彦培 Zhang Yuanyuan;Liu Xueli;Zhang Lei;Zhang Xiaoguang;Cheng Yanpei(Second Oncology Department,Handan Central Hospital,Handan O56000,China;Department of Inspection,Handan Central Hospital,Handan 056000,China)

机构地区：[1]邯郸市中心医院肿瘤内二科,邯郸056000 [2]邯郸市中心医院临检科,邯郸056000

出　　处：《中国医师杂志》2024年第7期1060-1065,1070,共7页Journal of Chinese Physician

基　　金：河北省医学科学研究重点课题计划(20191831)。

摘　　要：目的探讨阿帕替尼联合替雷利珠单抗治疗一线化疗失败的晚期胃癌患者的临床疗效,以及对患者外周血肿瘤血管生成调节因子水平和远期生存的影响。方法前瞻性选择邯郸市中心医院2020年1月至2021年12月收治的144例一线化疗失败的晚期胃癌患者作为研究对象,按随机数字表法分为两组,每组72例。其中对照组单用替雷利珠单抗治疗,观察组采用阿帕替尼联合替雷利珠单抗治疗,连续治疗4个疗程后观察两组近期疗效。比较治疗前后两组血清肿瘤标志物[癌胚抗原(CEA)、糖类抗原(CA)199、CA724、CA125]、肿瘤血管生成调节因子[血管内皮生长因子(VEGF)、基质细胞衍生因子1α(SDF-1α)、胰岛素样生长因子1(IGF-1)、基质金属蛋白酶-9(MMP-9)]水平,以及生活质量评分。对所有患者进行长期追踪随访,统计两组远期生存情况。比较两组不良反应情况。结果观察组客观缓解率、疾病控制率(51.39%、80.56%)均显著高于对照组(31.94%、61.11%,均P<0.05)。治疗后,两组血清CEA、CA199、CA724、CA125、VEGF、SDF-1α、IGF-1、MMP-9水平均较治疗前显著降低(均P<0.05),且观察组上述指标下降更明显(均P<0.05)。治疗后,两组欧洲癌症研究与治疗组织生命质量核心量表C30中躯体功能、情绪功能、社会功能、角色功能、总体健康状况评分均较治疗前显著升高(均P<0.05),且均以观察组增加更明显(均P<0.05)。观察组中位无进展生存期和中位总生存期分别为5.9个月、13.1个月,均较对照组(4.5个月、9.6个月)显著延长(均P<0.05)。治疗期间,两组均出现了不同程度的高血压、白细胞减少、血小板减少、肝肾损害等不良反应,但均以Ⅰ~Ⅱ度为主,总体不良反应临床可控,患者可耐受。观察组高血压、血小板减少、手足综合征、口腔溃疡的发生率均显著高于对照组(均P<0.05)。结论阿帕替尼联合替雷利珠单抗治疗一线化疗失败的晚期胃�Objective To explore the clinical efficacy of apatinib combined with tirelizumab in the treatment of advanced gastric cancer patients who failed first-line chemotherapy,as well as its impact on peripheral blood tumor angiogenesis regulatory factor levels and long-term survival.Methods A prospective study was conducted on 144 advanced gastric cancer patients who failed first-line chemotherapy and were admitted to the Handan Central Hospital from January 2020 to December 2021.They were divided into two groups using a random number table method,with 72 patients in each group.The control group was treated with tirezizumab alone,while the observation group was treated with apatinib combined with tirezizumab.After four consecutive courses of treatment,the short-term efficacy of both groups was observed.We compared the levels of serum tumor markers[carcinoembryonic antigen(CEA),carbohydrate antigen(CA)199,CA724,CA125],tumor angiogenesis regulatory factors[vascular endothelial growth factor(VEGF),stromal cell-derived factor-1α(SDF-1α),insulin-like growth factor-1(IGF-1),matrix metalloproteinase-9(MMP-9)],and quality of life scores between two groups before and after treatment.Long term follow-up was conducted on all patients,and the long-term survival status of two groups was statistically analyzed.Two groups of adverse reactions were compared.Results The objective remission rate and disease control rate(51.39%,80.56%)of the observation group were significantly higher than those of the control group(31.94%,61.11%,all P<0.05).After treatment,the serum levels of CEA,CA199,CA724,CA125,VECF,SDF-1α,IGF-1,and MMP-9 in both groups were significantly reduced compared with those before treatment(all P<0.05),and the observed group showed a more significant decrease in the above indicators(all P<0.05).After treatment,the scores of physical function,emotional function,social function,role function,and overall health status in the European Organization for Research and Treatment of Cancer Core Scale C30 were significantly higher t

关 键 词：胃肿瘤 阿帕替尼 替雷利珠单抗 血管生成调节因子 

分 类 号：R735.2[医药卫生—肿瘤]