阿帕替尼治疗化疗失败的晚期胃癌的效果及围治疗期相关癌变指标变化

目的研究阿帕替尼对化疗失败的晚期胃癌的有效性及围治疗期相关癌变指标的变化。方法选取2016年8月至2017年10月黄石市中心医院收治的68例化疗失败的晚期胃癌患者,按随机数字表随机分为研究组和对照组,各34例。两组患者均接受支持治疗,研究组在此基础上加用阿帕替尼。比较两组患者的疗效、不良反应发生率、血清癌胚抗原(CEA)、糖链抗原19 9(CA19 9)、糖链抗原72 4(CA72 4)等癌变指标的变化及远期预后情况。结果研究组治疗总有效率为382％,高于对照组的147％,差异有统计学意义(χ2=4836,P<005),研究组疾病控制率为676％,高于对照组的294％,差异有统计学意义(χ2=9950,P<005)。两组患者在治疗过程中均出现不同程度的不良反应,研究组的高血压和蛋白尿发生率均高于对照组(353％ vs. 147％,176％ vs. 0％),差异有统计学意义(P<005)。研究组患者治疗后CEA、CA19 9、CA72 4水平均低于治疗前,且均低于对照组(均P<005)。两组患者经治疗后均随访12个月,研究组的中位无进展生存期及中位生存期均长于对照组［(39±06)个月 vs. (21±04)个月,(62±09)个月 vs. (42±06)个月］,差异有统计学意义(均P<005)。结论阿帕替尼用于治疗化疗失败的晚期胃癌,可提高治疗有效率和疾病控制率,并能显著降低CEA、CA19 9及CA72 4等癌变指标的水平,患者远期预后良好,治疗后无严重不良反应,且可通过调节用药量对不良反应进行控制,安全性有保障,值得推广应用。

Study about the efficacy of apatinib in the progression of advanced gastric cancer with chemotherapy failure and the changes of cancerous indicators in perioperative period

Objective　To study the efficacy of apafitini in the progression of advanced gastric cancer with chemotherapy failure and the changes of cancer indicators in the perioperative period. Methods　68 patients admitted in Huangshi Central Hospital from August 2016 to October 2017 with advanced gastric cancer with failed chemotherapy were selected, and they were randomly divided into study group and control group according to the random number table, 34 cases in each group. Patients in both groups received supportive care, and the study group added apapitini on this basis. The efficacy, adverse reaction rate, Serum carcinoembryonic antigen (CEA), sugar chain antigen 19-9 (CA19-9), sugar chain antigen 72-4 (CA72-4) canceration indicators and long-term prognosis were compared between the two groups. Results　 The total effective rate of the study group was 38.2%, which was higher than 14.7% of the control group, the difference was statistically significant (2=4.836, P<0.05). The disease control rate of the study group was 67.6%, which was higher than 29.4% of the control group, the difference was statistically significant (2=9.950, P<0.05). Both groups of patients experienced different degrees of adverse reactions during the treatment. The incidence of hypertension and proteinuria in the study group were higher than those in the control group (35.3% vs. 14.7%, 17.6% vs. 0%), the difference was statistically significant (P<0.05). After treatment, the levels of CEA, CA19-9 and CA72-4 in the study group were lower than those before treatment (P<0.05), and were lower than the control group (P<0.05). Both groups were followed up for 12 months after treatment. The median progression-free survival and median survival of the study group were longer than the control group (3.9±0.6) months vs. (2.1±0.4) months, (6.2±0.9) months vs. (4.2±0.6) months], the difference was statistically significant (both P<0.05). Conclusion　Apatinib in the treatment of advanced gastric cancer with chemotherapy failure, which can improve the treatment efficiency and disease control rate, and can significantly reduce the levels of CEA, CA19-9, CA72-4 cancerous indicators. The long-term prognosis is good. There is no serious adverse reaction after treatment, and the adverse reactions can be controlled by adjusting the dosage, and the safety is guaranteed, which is worthy of popularization and application.