吉西他滨联合替吉奥治疗难治性鼻咽癌的疗效及其对免疫功能的影响

目的 评价吉西他滨联合替吉奥方案治疗难治性鼻咽癌的临床疗效，及化疗前后外周血T淋巴细胞亚群的动态变化。方法 回顾性收集42例难治性鼻咽癌患者资料，给予吉西他滨联合替吉奥化疗。吉西他滨1.0 g/m²，分别于第1天和第8天静脉滴注；替吉奥40 mg/m²，口服，2次/天，d1~14。21天为1周期，所有病例均接受至少2周期化疗。收集患者化疗前后外周血，检测患者化疗前后的T细胞亚群变化。采用单因素对数秩检验（Log rank test）进行生存分析和多因素Cox比例风险回归模型分析预后因素。结果 42例患者均完成计划化疗方案和随访。其中完全缓解1例，部分缓解21例，稳定12例，进展8例，有效率为52.4%（22/42），疾病控制率为81.0%（34/42），中位疾病进展时间为6.8月，中位生存时间为14.6月。常见不良反应有骨髓抑制、胃肠道反应、皮疹、疲劳等，无治疗相关死亡。与进展组患者比较，有效组患者化疗后CD3⁺、CD3⁺CD4⁺细胞百分比升高，CD4⁺/CD8⁺升高。多因素分析表明是否出现肝转移是影响预后的独立危险因素。结论 吉西他滨联合替吉奥治疗难治性鼻咽癌患者疗效肯定，不良反应可以耐受，是否出现肝转移是影响预后的独立危险因素。化疗有效者外周血T淋巴细胞亚群变化更为明显。

Clinical Efficacy of Gemcitabine plus S-1 on Refractory Nasopharyngeal Carcinoma Patients and Their Influence on Immune Function

Objective To investigate the efficacy of gemcitabine plus S-1 on refractory nasopharyngeal carcinoma patients, and to detect the changes of T lymphocyte subsets in the peripheral blood before and after chemotherapy. Methods Forty-two refractory nasopharyngeal carcinoma patients received gemcitabine (1.0 g/m² on day 1 and day 8) plus oral S-1 chemotherapy (40mg/m² twice daily, d1-14). Each cycle was repeated every 21 days, two cycles at least for each patient. The peripheral blood samples were collected before and after chemotherapy respectively, then T lymphocyte subsets were analyzed by flow cytometry. Survival analysis included univariate model and multivariate Cox regression model. Results Forty-two patients had completed chemotherapy and follow-up. There was one case of complete response, 21 cases of partial responses, 12 cases of stable disease, 8 cases of progressive disease, the overall response rate was 52.4%(22/42), and the disease control rate was 81.0%(34/42). Median time to progression was 6.8 months and median survival was 14.6 months. The common adverse effects were myelosuppression, gastrointestinal tract reaction, rash and fatigue; no death occurred in relation to the therapy. Compared with PD group, the percentages of CD3⁺, CD3⁺CD4⁺ and CD4⁺/CD8⁺ ratios were increased significantly in the response group after chemotherapy. Liver metastasis was an independent prognostic factor for overall survival. Conclusion Gemcitabine plus S-1 are an effective therapy with tolerable toxicity profile for refractory NPC patients. Liver metastasis is an independent prognostic factor for overall survival. Effective chemotherapy influences T lymphocyte subsets obviously.