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目的探讨贝伐珠单抗联合术前化疗治疗结直肠癌肝转移的有效性和安全性。方法回顾性分析2009年5月至2013年8月中山大学肿瘤防治中心收治的89例结直肠癌肝转移患者临床资料。患者均签署知情同意书,符合医学伦理学规定。按照一线化疗方式分为贝伐珠单抗联合术前化疗组(单抗组,32例)和单纯术前化疗组(化疗组,57例)。单抗组男24例,女8例;年龄29~74岁,中位年龄59岁;结肠癌22例,直肠癌10例。化疗组男42例,女15例;年龄28~74岁,中位年龄57岁;结肠癌42例,直肠癌15例。观察比较两组患者的肿瘤无进展生存时间,肝转移瘤反应率、切除率、转化率及术前治疗不良反应事件发生率。率的比较采用χ~2检验,生存分析采用KaplanMeier法和Log-rank检验。结果单抗组中位肿瘤无进展生存时间为16个月,化疗组13个月,两组肿瘤无进展生存率比较差异无统计学意义(χ~2=0.030,P>0.05)。单抗组肝转移瘤反应率、切除率、转化率分别为59%(19/32)、69%(22/32)、53%(17/32),化疗组相应为39%(22/57)、54%(31/57)、40%(23/57),两组差异无统计学意义(χ~2=3.561,1.755,0.983;P>0.05)。单抗组总体不良反应事件发生率为12%(4/32),其中2例中性粒细胞下降,1例手足综合征和1例Ⅲ度牙龈出血;化疗组为9%(5/57),其中3例血小板下降,1例中性粒细胞下降和1例肝功能损害;两组比较差异无统计学意义(χ~2=0.313,P>0.05)。结论贝伐珠单抗联合术前化疗治疗结直肠癌肝转移是安全的,有望使结直肠癌肝转移患者获得更长无瘤生存期,可能有潜在疗效。
Objective To investigate the efficacy and safety of bevacizumab combined with preoperative chemotherapy in the treatment of liver metastases from colorectal cancer. Methods The clinical data of 89 patients with liver metastases from colorectal cancer who were admitted to Cancer Center of Sun Yat-sen University from May 2009 to August 2013 were retrospectively analyzed. All patients signed informed consent, in line with medical ethics rules. According to the first-line chemotherapy, bevacizumab combined with preoperative chemotherapy (monoclonal antibody group, 32 cases) and simple preoperative chemotherapy group (chemotherapy group, 57 cases). Monoclonal antibody group 24 males and 8 females; aged 29 to 74 years old, the median age of 59 years; 22 cases of colon cancer, rectal cancer in 10 cases. Chemotherapy group of 42 males and 15 females; aged 28 to 74 years old, the median age of 57 years; 42 cases of colon cancer, rectal cancer in 15 cases. The progression-free survival, liver metastasis response rate, resection rate, conversion rate and incidence of preoperative adverse reactions were compared between the two groups. Rate comparison using χ ~ 2 test, survival analysis using KaplanMeier method and Log-rank test. Results The median progression-free survival time of the median tumor in the monoclonal antibody group was 16 months, while the chemotherapy group was 13 months. There was no significant difference in progression-free survival between the two groups (χ ~ 2 = 0.030, P> 0.05). The response rates, resection rates, and conversion rates of liver metastases were 59% (19/32), 69% (22/32), 53% (17/32) in the monoclonal antibody group and 39% (22/57) in the chemotherapy group ), 54% (31/57) and 40% (23/57) respectively. There was no significant difference between the two groups (χ ~ 2 = 3.561,1.755,0.983; P> 0.05). The overall incidence of adverse events in the mAb group was 12% (4/32), with 2 neutropenia, 1 hand-foot syndrome, and 1 case of grade 3 bleeding. The chemotherapy group was 9% (5/57) , 3 cases of thrombocytopenia, 1 case of neutrophil decline and 1 case of liver dysfunction; There was no significant difference between the two groups (χ ~ 2 = 0.313, P> 0.05). Conclusion Bevacizumab combined with preoperative chemotherapy for the treatment of colorectal cancer liver metastasis is safe, is expected to make patients with liver metastases of colorectal cancer longer tumor-free survival may have a potential effect.