白蛋白结合型紫杉醇联合顺铂及阿帕替尼在晚期宫颈癌治疗中的临床效果研究

Clinical Effect of Albumin-bound Paclitaxel Combined with Cisplatin and Apatinib in the Treatment of Advanced Cervical Cancer

关键词:  白蛋白结合型紫杉醇  顺铂  阿帕替尼  宫颈癌  细胞免疫

Key words:  albumin-bound paclitaxet  cisplatin  apatinib  cervical cancer  cellular immune

摘要:

目的 观察白蛋白结合型紫杉醇联合顺铂及阿帕替尼治疗晚期宫颈癌的临床疗效，并对其安全性及药物经济学进行评价。方法 选取2018年2月—2019年2月期间笔者所在医院就诊的84例晚期宫颈癌患者为研究对象，随机分为观察组和对照组，每组42例。对照组患者采取白蛋白结合型紫杉醇175 mg·m^-2·d^-1+顺铂60 mg·m^-2·d^-1的治疗方案，观察组患者在对照组的基础上加用阿帕替尼500 mg·d^-1，治疗21 d为1个周期，2组患者均治疗4个周期后评价疗效、不良反应及成本-效果比；分别于治疗前后检测2组患者血清CD3+、CD4+、CD8+和NK细胞的表达；分别于治疗前后检测2组患者血清诱骗受体3（decoy receptor 3，DcR3）和Survivin的表达；治疗结束后对患者进行随访，比较2组患者的生存率。结果 研究期间共有8名患者脱落，每组各4例，故最终各组38例。观察组总缓解率（73.67%）高于对照组（34.21%），差异有统计学意义（P<0.05）。治疗后2组患者的CD3+、CD4+、NK细胞及CD4+/CD8+值较治疗前均有所下降（P<0.05），CD8+有所提高（P<0.05）；与对照组治疗后相比，观察组治疗后CD3+、CD4+、CD8+、CD4+/CD8+值及NK均无统计学差异。治疗后血清DcR3和Survivin的浓度较治疗前均显著降低（P<0.05）；与对照组相比，观察组更低，差异具有统计学意义（P<0.05）。观察组6，12个月的生存率高于对照组，2组之间具有统计学差异（P<0.05）。2组患者不良反应无统计学差异。观察组成本效果比低于对照组。结论 白蛋白结合型紫杉醇联合顺铂及阿帕替尼治疗晚期宫颈癌患者效果良好，不良反应可控，成本-效果比低，值得临床推广。

Abstract:

OBJECTIVE To observe the clinical efficacy, safety and economy of albumin-bound paclitaxel combined with cisplatin and apatinib in the treatment of advanced cervical cancer. METHODS Eighty-four patients with advanced cervical cancer treated in author's hospital from February 2018 to February 2019 were randomly divided into control group and observation group. Patients in the control group were treated with albumin-bound paclitaxel 175 mg·m^-2·d^-1+cisplatin 60 mg·m^-2·d^-1, and patients in the observation group were treated with apatinib 500 mg·d^-1 on the basis of the control group. Twenty one days treatment for 1 cycle. The efficiency, adverse reactions and ratio of cost-effectiveness were evaluated after 4 treatment cycles for 2 groups. Expression of serum CD3+, CD4+, CD8+ and NK cells were detected before and after treatment; serum expression levels of decoy receptor 3(DcR3) and Survivin were detected before and after the treatment; follow-ups were conducted after the treatment to evaluate the survival rate. RESULTS Eight patients(4 for each group) were departed during the research, so the number of patients of both groups were 38. The total remission rate of observation group(73.67%) was higher than that of control group(34.21%)(P<0.05). Serum CD3+, CD4+, CD4+/CD8+ and NK cells were decreased and CD8+ of 2 groups were increased after the treatment(P<0.05), and there was no significant difference between control group and observation group after the treatment. Serum DcR3 and Survivin were decreased after the treatment(P<0.05); the observation was lower as compared with control group(P<0.05). The survival rate of 6 months and 12 months of observation group were higher than that of control group(P<0.05). There was no significant difference of adverse reactions between two groups. CONCLUSION Albumin- bound paclitaxel combined with cisplatin and apatinib is effective in the treatment of advanced cervical cancer with controllable adverse reactions and low ratio of cost-effectiveness, which is worthy of clinical promotion.