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拉帕替尼联合紫杉醇对HER2阳性晚期胃癌患者恶性分子、免疫功能及预后的影响
作者:辛永利  潘笑利 
单位:河南科技大学第三附属医院  洛阳东方医院普外科  河南 洛阳 471003 
关键词:胃肿瘤/药物疗法 胃肿瘤/病理学 基因 erbB-2 受体蛋白质酪氨酸激酶类/拮抗剂和抑制剂 紫杉酚/投药和剂量 紫杉酚/治疗应用 抗肿瘤药/投药和剂量 抗肿瘤药/治疗应用 肿瘤标记 生物学 预后 治疗结果 
DOI:R735.2;R730.53
出版年,卷(期):页码:2017,32(6):525-529
摘要:

目的 探讨拉帕替尼联合紫杉醇对人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)阳性的晚期胃癌患者恶性分子、免疫功能及预后的影响。方法 选取术后病理组织显示为HER2阳性的患者30例,根据入院时间偶数日期为拉帕替尼联合紫杉醇组,奇数日期为紫杉醇组,各15例。紫杉醇组仅给予紫杉醇(135~200 mg/m2,连续治疗3 d,间隔35 d),拉帕替尼联合紫杉醇组给予紫杉醇(135~175 mg/m2,连续治疗3 d,间隔35 d)联用拉帕替尼(1 250 mg/m2,连续14 d)。比较两组患者的周期数。检测并比较治疗前、后两组恶性分子水平[成纤维细胞生长因子2(fibroblast growth factor 2,FGF-2)、FGF-19、碱性成纤维细胞生长因子(basic fibroblast growth factor,bFGF)和成纤维细胞生长因子受体4(fibroblast growth factor receptor 4,FGFR-4)]和免疫细胞水平[外周血细胞分化抗原(cell differentiation antigen,CD)3+、CD4+、CD8+和CD4+/CD8+]。随访3年,比较两组生存情况。结果 拉帕替尼联合紫杉醇组治疗周期数少于紫杉醇组[(3.12±0.58)vs(4.23±1.02),P<0.05],但两组不良反应发生率比较,差异无统计学意义(P>0.05)。与紫杉醇组比较,拉帕替尼联合紫杉醇组治疗后血清恶性分子水平下降更明显,而T淋巴细胞水平升高更明显,两组比较差异均具有统计学意义(均P<0.05)。与紫杉醇组比较,拉帕替尼联合紫杉醇组3年生存率更高(46.7% vs 30.0%),但两组比较差异无统计学意义(P>0.05)。结论 拉帕替尼联合紫杉醇可降低HER2阳性的晚期胃癌患者恶性分子水平,改善其免疫功能,有改善预后的趋势,安全性好。

Objective To evaluate the immune function and prognosis in patients with human epidermal growth factor receptor 2(HER2)-positive advanced gastric cancer following lapatinib combined with paclitaxel therapy. Methods Thirty patients with pathologically confirmed HER2-positive advanced gastric cancer were randomly assigned to two groups with 15 cases in each group:patients in the study group were treated with lapatinib (1 250 mg/m2, for 14 d) plus paclitaxel (135-175 mg/m2, for 3 d with a cycle interval of 35 d) and patients in the control group were treated with paclitaxel (135-200 mg/m2, for 3 d with a cycle interval of 35 d). Serum levels of fibroblast growth factor 2(FGF-2), FGF-19, basic fibroblast growth factor (bFGF) and fibroblast growth factor receptor 4(FGFR-4), peripheral blood cell differentiation antigen(CD)3+, CD4+, CD8+ and CD4+/CD8+ were measured before and after treatment in both groups. The patients were followed up for 3 years, and the survival rate was compared between the two groups.Results The number of treatment cycle was less in the study group than that in the control group[(3.12±0.58) vs (4.23±1.02), P<0.05]. However, the incidence of adverse reactions was comparable between the two groups (P>0.05). Compared with the control group, the serum levels of FGF-2/19, bFGF and FGFR-4 were decreased more significantly in the study group, and the T lymphocytes were significant increased after treatment (both P<0.05). The study group showed an increasing trend of 3-year survival rate than the control group (46.7% vs 30.0%, P>0.05). Conclusion Lapatinib combined with paclitaxel can significantly reduce serum levels of FGF-2/19, bFGF and FGFR-4, and improve immune function and prognosis of patients with HER2-positive advanced gastric cancer.

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