| 殷国庆,王忠,周峰,等.阿帕替尼辅助标准化疗对晚期胃癌合并肝转移病人疗效及安全性的影响[J].安徽医药,2020,24(8):1628-1631. |
| 阿帕替尼辅助标准化疗对晚期胃癌合并肝转移病人疗效及安全性的影响 |
| Influence of apatinib combined with standard chemotherapy on clinical efficacy and safety of patients with advanced gastric cancer combined with liver metastasis |
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| DOI：10.3969/j.issn.1009?6469.2020.08.039 |
| 中文关键词: 胃肿瘤 /药物疗法 阿帕替尼 抗肿瘤联合化疗方案 血管内皮生长因子类 基质金属蛋白酶 9 治疗结果 肿瘤转移 |
| 英文关键词: Stomach neoplasms/drug therapy Apatinib Antineoplastic combined chemotherapy protocols Vascular endothelial growth factors Matrix metalloproteinase 9 Treatment outcome Metastasis |
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| 中文摘要: |
| 目的探讨阿帕替尼辅助标准化疗对晚期胃癌合并肝转移病人疗效及安全性的影响。方法选取延安大学咸阳医院 2015年 3月至 2017年 3月收治晚期胃癌伴肝转移病人共 130例，采用随机数字表法分为对照组(65例)和观察组(65例)，对照组采用标准化疗方案，观察组在此基础上加用阿帕替尼辅助治疗；比较两组临床疗效，生存时间，治疗前后血管内皮生长因子(VEGF)、人基质金属蛋白酶 ?9(MMP?9)水平及毒副作用发生率，并分析预后危险因素。结果观察组客观缓解率 26.15%和疾病控制率 84.62%均显著高于对照组 16.92%、70.77%(P＜0.05)；对照组中位无进展生存时间和总生存时间分别为 3.4个月， 5.8个月；观察组分别 5.5个月， 9.4个月，观察组均显著长于对照组(P＜0.05)；观察组治疗后 MMP?9和 VEGF水平均显著低于对照组、治疗前(P＜0.05)；两组恶心呕吐、骨髓抑制、外周感觉神经异常及口腔炎发生率比较，均差异无统计学意义(P＞0.05)；观察组手足综合征和高血压发生率均显著高于对照组(P＜0.05)；根据 COX回归分析结果显示，病理类型和肝转移灶数目是影响胃癌肝转移病人预后独立危险因素(HR＝0.476，0.426，95%CI:0.251~0.869，0.237~0.740，P＝0.013，0.001)。结论阿帕替尼辅助标准化疗治疗晚期胃癌合并肝转移可有效延缓疾病进展，延长生存时间，但可能增加手足综合征和高血压发生风险；其所具有疗效优势可能与抑制 MMP?9和 VEGF表达密切相关；同时胃癌肝转移病人预后与病理类型、肝转移灶数目密切相关。 |
| 英文摘要: |
| Objective To investigate the influence of apatinib combined with standard chemotherapy on clinical efficacy and safetyof patients with advanced gastric cancer combined with liver metastasis.Methods A total of 130 patients with advanced gastric cancer combined with liver metastasis，who were treated in The Xianyang Hospital Affiliated to Yan’an University from March 2015 to March 2017，were chosen and randomly assigned into control group(65 patients)and observation group(65 patients).The control group adopted standard chemotherapy and the observation group used apatinib additionally.The clinical efficacies，survival time，the levels of MMP?9 and vascular endothelial growth factor(VEGF)before and after treatment and the incidence of adverse effects of both groups were compared.Risk factors of prognosis were also analyzed.Results The ORR(26.15% vs. 16.92%)and DCR(84.62% vs. 70.77%)of the observation group were significantly higher than the control group(P＜0.05).The median PFS(5.5 months vs. 3.4 months)and OS(9.4 months vs. 5.8 months)of the observation group were significantly longer than the con? trol group(P＜0.05).The levels of MMP?9 and VEGF of the observation group after treatment were significantly lower than thoseof the control group and before treatment(P＜0.05).There were no significant differences in the incidence of vomiting，bone mar? row suppression，peripheral sensory nerve abnormalities and stomatitis between two groups(P＞0.05).The incidences of hand?foot syndrome and hypertension of the observation group were significantly higher than the control group(P＜0.05).COX regressionanalysis showed that pathological type and number of liver metastases were independent risk factors for prognosis of patients withliver metastasis of gastric cancer(HR＝0.476，0.426，95%CI:0.251-0.869，0.237-0.740，P＝0.013，0.001).Conclusion Apatinib combined with standard chemotherapy in the treatment of patients with advanced gastric cancer combined with liver metastasis canefficiently delay disease progression，prolong survival，but may increase the risk of hand?foot syndrome and hypertension，and its therapeutic advantages may be closely related to the inhibition of MMP?9 and VEGF expressions.Meanwhile the prognosis of pa?tients with liver metastases from gastric cancer may be closely related to pathological type and the number of liver metastases. |
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