血管内皮生长因子检测在阿司匹林联合Capox方案治疗老年转移性结肠癌的临床意义

目的分析转移性结肠癌(mCRC)中血管内皮生长因子(VEGF)与阿司匹林(ASA)联合化疗疗效的关系,探讨ASA在mCRC中的可能机制。方法 74例无出血倾向的mCRC患者随机分2组:33例Capox方案组病例单纯接受化疗卡培他滨1 000 mg·(m2)-1·d-1,每日2次,第1¹4天;奥沙利铂130 mg/m2,第1天。每3周为1周期];41例Capox联合ASA组接受化疗外,于化疗期及化疗间歇期均持续口服ASA 75 mg/d,同时口服奥美拉唑20 mg/d保护胃黏膜。每周期化疗前均抽取静脉血检测VEGF含量。结果 (1)Capox+ASA组DCR显著高于Capox组(92.7%vs.66.7%,P<0.05),但两组OR无差异(45.5%vs.63.4%,P>0.05);(2)两组病例中,获DCR疗效亚组VEGF含量均明显低于PD疗效亚组(594.1±32.6 vs.1 029.8±58.8,477.1±13.3 vs.1 003.4±50.9,P<0.05);在DCR疗效亚组,Capox+ASA组VEGF含量显著低于Capox组(P<0.05),但在PD疗效亚组Capox组与Capox+ASA组VEGF含量无显著性差异(P>0.05)。结论 ASA联合Capox治疗老年转移性结肠癌患者,提高了疾病控制率,ASA部分抗癌机制为抑制VEGF表达。

Clinical implication of VEGF in elderly patients with metastatic colon cancer treated by low-dose aspirin plus Capox regimen

Objective To investigate the correlation between VEGF and outcome of ASA plus chemotherapy in elderly patients with metastatic colon cancer（mCRC） and explore the possible anticancer mechanism of ASA. Methods 74 cases with mCRC without haemorrhage tendency were assigned into two groups randomly： the Capox regimen group received chemotherapy alone（i.e capecitabine 1 000 mg/m^2 bid, d1-14; oxaliplatin, 130 mg/m^2, d1）; the Capox regimen plus low-dose aspirin group receive chemotherapy and regular intake of aspirin（75 mg/d）, together with oral administration of omeprazole（20 mg/d） against gastric mucosal injury. The level of VEGF in serum was measured prior to each chemotherapy. Results（1） Significant difference in disease-control rate（DCR） was found between the Capox group and the combined group（92.7% vs. 66.7%, P〈0.05）, but was not in overall response rate（OR）（45.5% vs. 63.4%, P〈0.05）.（2） In the two groups, the serum concentration of VEGF in patients achieving DCR was higher than that in patients experiencing PD（594.1±32.6 vs. 1 029.8±58.8, 477.1±13.3 vs. 1 003.4±50.9, P〈0.05）. For those achieving DCR, VEGF level was marked higher in Capox＋ASA group than in Capox group（P〈0.05）. For patients with PD, no similar difference existed between the two groups. Conclusion The Capox regimen in combined with low-dose ASA can improve the clinical outcomes of elderly patients with mCRC. The underlying anti-cancer mechanism of ASA may be partly attributed to inhibition of VEGF.