重组人血管内皮抑素结合多西紫杉醇动脉介入治疗结直肠癌肝转移的临床效果

摘要/Abstract

摘要： 目的观察重组人血管内皮抑素结合多西紫杉醇综合方案动脉介入治疗结直肠癌肝转移的临床效果。方法选取2020年2月至2022年5月就诊于三亚市人民医院肿瘤科的110例结直肠癌肝转移患者,采用单双数分组法分为两组。对照组给予多西紫杉醇综合方案动脉介入治疗,观察组在多西紫杉醇综合方案动脉介入基础上结合重组人血管内皮抑素治疗。比较两组高尔基体蛋白73(GP73)、癌胚抗原(CEA)、网膜素-1(Omentin-1)、细胞角蛋白19片段(CYFRA21-1)差异,评估整体生存质量,记录近期和远期疗效。结果观察组近期客观缓解率(ORR)为61.82%(34/55),高于对照组的41.82%(23/55),差异有统计学意义(P<0.05)。比较治疗前GP73、CEA、Omentin-1、CYFRA21-1,差异无统计学意义(P>0.05)。两组治疗后GP73、CEA、Omentin-1、CYFRA21-1均较治疗前下降(P<0.05),观察组较对照组更低(P<0.05)。观察组整体KPS评分优于对照组,差异有统计学意义(P<0.05)。随访截止2023年8月,随访4~18个月,中位随访时间10.47个月,对照组中位无进展生存时间4.5个月,观察组无进展生存时间7.7个月,差异有统计学意义(P<0.05)。所有患者不良反应均为1-2级,未发生3-4级。两组贫血、中性粒细胞降低、腹泻、AST或ALT升高、血小板降低、血压升高、恶心呕吐发生率比较,差异无统计学意义(P>0.05)。结论重组人血管内皮抑素结合多西紫杉醇综合方案动脉介入治疗结直肠癌肝转移可抑制GP73、CEA等因子的表达,提高近期和远期疗效,且不会增加不良反应风险。

关键词: 重组人血管内皮抑素, 多西紫杉醇, 动脉介入, 结直肠癌, 肝转移

Abstract: Objective To observe the clinical efficacy of a comprehensive regimen combining recombinant human vascular endothelial inhibitor with doxorubicin in arterial intervention therapy for the treatment of colorectal cancer liver metastases. Methods In this study, 110 patients with colorectal cancer liver metastasis who were diagnosed from February 2020 to May 2022 were selected and divided into two groups by using an odd-even grouping method. The control group was given arterial intervention treatment with doxorubicin comprehensive therapy, and the observation group was combined with recombinant human vascular endothelial inhibitor treatment. The differences in Golgi protein 73 (GP73), carcinoembryonic antigen (CEA), omentin-1, and cytokeratin 19 fragment (CYFRA21-1) were compared between the two groups, and the overall quality of survival was assessed, and the immediate and long-term efficacy of the two groups was recorded. Results There was no statistical difference in GP73, CEA, Omentin-1 and CYFRA21-1 levels in these two groups before treatment (P>0.05). The levels significantly decreased in both groups after treatment (P<0.05), and was significantly lower in the observation group when compared with those of the control group (P<0.05). The overall Karnofsky Performance Status (KPS) score of the observation group was better than that of the control group (P<0.05). All patients had grade 1-2 toxic side effects, and no grade 3-4 toxic side effects occurred. There was no statistical difference in the incidence of anemia, thrombocytopenia, neutropenia, diarrhea, elevated AST or ALT, elevated blood pressure, nausea and vomiting between the two groups (P>0.05). The recent Objective remission rate (ORR) of 61.82% (34/55) in the observation group was higher than that of 41.82% (23/55) in the control group, which was statistically different (P<0.05).The follow-up of patients ended in August 2023, with a follow-up period of 4~18 months and a median follow-up period of 10.47 months, with a median progression-free survival time of 4.5 months in the control group and 7.7 months in the observation group. Conclusion A comprehensive regimen of arterial intervention with doxorubicin in combination of recombinant human vascular endothelial inhibitor for the treatment of colorectal cancer liver metastases inhibits the expression of GP73, CEA, and other factors, improves immediate and long-term efficacy,without increasing the risk of adverse effects.

Key words: Recombinant human vascular endothelial inhibitor, Doxorubicin, Arterial intervention, Colorectal cancer, Liver metastasis

郭仁芬, 柴芳, 邢孔浪, 张七妹, 李苇. 重组人血管内皮抑素结合多西紫杉醇动脉介入治疗结直肠癌肝转移的临床效果[J]. 肝脏, 2024, 29(6): 657-661.

GUO Ren-fen, CHAI Fang, XING Kong-lang, ZHANG Qi-mei, LI Wei. The clinical efficacy of a comprehensive regimen combining recombinant human vascular endothelial inhibitor with doxorubicin in arterial intervention therapy for the treatment of colorectal cancer liver metastases[J]. Chinese Hepatolgy, 2024, 29(6): 657-661.

/ 推荐

参考文献

[1] Mahmoud NN. Colorectal cancer: preoperative evaluation and staging[J]. Surg Oncol Clin N Am,2022,31(2):127-141.
[2] Zhou E, Rifkin S. Colorectal cancer and diet: risk versus prevention, is diet an intervention?[J] Gastroenterol Clin North Am,2021,50(1):101-111.
[3] Morgan E, Arnold M, Gini A, et al. Global burden of colorectal cancer in 2020 and 2040: incidence and mortality estimates from GLOBOCAN[J]. Gut,2023,72(2):338-344.
[4] Baidoun F, Elshiwy K, Elkeraie Y, et al. Colorectal cancer epidemiology: recent trends and impact on outcomes[J]. Curr Drug Targets,2021,22(9):998-1009.
[5] Dekker E, Tanis PJ, Vleugels JLA, et al. Colorectal cancer[J]. Lancet,2019,394(10207):1467-1480.
[6] Sutphin PD, Ganguli S. Interventional treatment of hepatic metastases from colorectal cancer[J]. Semin Intervent Radiol,2020,37(5):492-498.
[7] Al Bitar S, El-Sabban M, Doughan S, et al. Molecular mechanisms targeting drug-resistance and metastasis in colorectal cancer: updates and beyond[J]. World J Gastroenterol,2023,29(9):1395-1426.
[8] Guan L. Endostar rebuilding vascular homeostasis and enhancing chemotherapy efficacy in cervical cancer treatment[J]. Onco Targets Ther,2020,13:12811-12827.
[9] 王翠翠,车小川,李少欣. 重组人血管内皮抑素治疗晚期NSCLC的价值[J]. 实用癌症杂志,2019,34(11):1828-1831.
[10] 中华医学会外科学分会胃肠外科学组,中华医学会外科学分会结直肠外科学组,中国抗癌协会大肠癌专业委员会,等. 中国结直肠癌肝转移诊断和综合治疗指南(2018版)[J]. 中华消化外科杂志,2018,17(6):527-539.
[11] Stedman MR, Watford DJ, Chertow GM, et al. Karnofsky performance score-failure to thrive as a frailty proxy? [J]Transplant Direct,2021,7(7):e708.
[12] 张景岚. 结直肠癌肝转移瘤局部介入治疗应用进展[J]. 实用肿瘤学杂志,2020,34(1):79-82.
[13] 祝晓蕾. 对肝动脉栓塞化疗后中晚期肝癌患者采取重组人血管内皮抑制素治疗的效果分析[J]. 中国现代药物应用,2021,15(16):160-163.
[14] Wu J, Zhao X, Sun Q, et al. Synergic effect of PD-1 blockade and endostar on the PI3K/AKT/mTOR-mediated autophagy and angiogenesis in Lewis lung carcinoma mouse model[J]. Biomed Pharmacother,2020,125:109746.
[15] Idiiatullina E, Al-Azab M, Walana W, et al. EnDuo, a novel derivative of endostar, inhibits the migration of colon cancer cells, suppresses matrix metalloproteinase-2/9 expression and impedes AKT/ERK activation[J]. Biomed Pharmacother,2021,134:111136.
[16] Almajidi YQ, Kadhim MM, Alsaikhan F, et al. Doxorubicin-loaded micelles in tumor cell-specific chemotherapy[J]. Environ Res,2023,227:115722.
[17] 陈磊,丁德权,何昌霞. 重组人血管内皮抑素联合多西紫杉醇治疗胃癌恶性腹腔积液的疗效[J]. 中国肿瘤临床与康复,2015,22(10):1215-1217.
[18] de la Torre P, Paris JL, Fernández-de la Torre M, et al. Endostatin genetically engineered placental mesenchymal stromal cells carrying doxorubicin-loaded mesoporous silica nanoparticles for combined chemo- and antiangiogenic therapy[J]. Pharmaceutics,2021,13(2):244.