贝伐珠单抗联合mFOLFOX6治疗转移性结直肠癌的临床疗效及左右半结肠癌的疗效差异

目的:观察贝伐珠单抗联合mFOLFOX6对比mFOLFOX6治疗晚期转移性结直肠癌的疗效及不良反应，并探索性地分析了左右半结肠癌的疗效差异性。方法:选取2017年1月至2018年8月在江门市中心医院肿瘤科确诊的72例晚期转移性结直肠癌患者，贝伐珠单抗+mFOLFOX6组33例，mFOLFOX6组39例，分析两组的治疗效果、中位PFS、不良反应，并分析不同治疗方案对左右半结肠癌疗效的影响。 结果:贝伐珠单抗+mFOLFOX6组ORR为45.5%，DCR为84.8%；mFOLFOX6组ORR为38.5%，DCR为79.5%。Kaplan-Meier分析显示mFOLFOX6组与贝伐珠单抗+mFOLFOX6组的中位PFS分别为6.2个月和7.7个月（P=0.06）。COX多因素分析结果显示贝伐珠单抗+mFOLFOX6组及mFOLFOX6组的PFS差异有统计学意义（P=0.024），治疗线数对PFS的影响未达统计学差异（P=0.059）。Kaplan-Meier分析显示贝伐珠单抗+mFOLFOX6组中右半结肠癌的PFS为6.9个月，左半结肠癌的PFS为8.1个月（P=0.538）；mFOLFOX6组中右半结肠癌的PFS为6.37个月，左半结肠癌的PFS为6.2个月（P=0.209）。两组的不良反应主要为胃肠道反应、骨髓抑制及神经毒性。与贝伐珠单抗相关的不良反应主要为高血压、蛋白尿及血栓形成，除1例高血压为Ⅲ级外，其余均为Ⅰ-Ⅱ级。结论:贝伐珠单抗+mFOLFOX6治疗晚期转移性结直肠癌患者疗效好，不良反应可耐受，对左半结肠癌的PFS有获益的趋势。

The clinical efficacy of bevacizumab combined with mFOLFOX6 in the treatment of metastatic colorectal cancer and the difference between left and right colon cancer

Objective:To observe the efficacy and toxicity of bevacizumab combined with mFOLFOX6 in the treatment of advanced metastatic colorectal cancer，and to explore the difference in the efficacy of left and right colon cancer.Methods:72 patients with advanced metastatic colorectal cancer，33 cases in bevacizumab + mFOLFOX6 group and 39 cases in mFOLFOX6 group，were selected from January 2017 to August 2018 in the oncology department of Jiangmen Central Hospital.The therapeutic effects，median PFS and toxicity of the two groups were analyzed，and the effects of different treatment schemes on the effect of left and right colon cancer were analyzed.Results:The objective response rate (ORR) was 45.5% and the disease control rate (DCR) was 84.8% in bevacizumab+mFOLFOX6 group.The ORR was 38.5% and the DCR was 79.5% in mFOLFOX6 group.Kaplan-Meier analysis showed that the median PFS of mFOLFOX6 group and bevacizumab+mFOLFOX6 group were 6.2 months and 7.7 months，respectively（P=0.06）.COX multivariate analysis showed that bevacizumab+mFOLFOX6 group and mFOLFOX6 group had significant effect on PFS (P= 0.024)，while the number of treatment lines had no significant effect on PFS (P=0.059).Kaplan-Meier analysis showed that PFS of right and left colon cancer was 6.9 months and 8.1 months in bevacizumab + mFOLFOX6 group (P=0.538),and PFS of right and left colon cancer was 6.37 months and 6.2 months in mFOLFOX6 group (P=0.209).The main side effects of the two groups were gastrointestinal reaction，bone marrow suppression and neurotoxicity.The main side effects associated with bevacizumab were hypertension，proteinuria and thrombosis.Except for one case of hypertension with grade III，the others were grade I-II.Conclusion:Bevacizumab+mFOLFOX6 is effective and tolerable in the treatment of advanced metastatic colorectal cancer.It has a tendency to benefit PFS of left colon cancer.