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目的观察低分化结直肠腺癌与高中分化结直肠腺癌用XELOX方案治疗的临床疗效差异。方法 80例结直肠腺癌患者分为对照组40例(低分化结直肠腺癌)和试验组40例(高、中分化结直肠腺癌)。2组患者均使用XELOX方案进行治疗,第1天,静脉滴注奥沙利铂130 mg·m~(-2),滴注3 h,第1~14天,口服卡培他滨1000 mg·m~(-2),早晚各1次,持续用药2周,3周为1个疗程,共治疗3个疗程。观察2组患者治疗前后人转录激活因子5(ATF5)mRNA及B细胞淋巴瘤~(-2)(Bcl~(-2))mRNA相对含量的变化,比较2组患者的临床疗效、药物不良反应发生率,观察2组患者的远期生存率。结果治疗后,试验组ATF5mRNA相对含量为0.43±0.07,Bcl~(-2) mRNA相对含量为0.33±0.04,对照组的ATF5 mRNA相对含量为1.52±0.09,Bcl~(-2) mRNA相对含量为0.78±0.10,差异有统计学意义(P<0.05)。试验组总有效率为87.50%(35/40例),对照组总有效率为60.00%(24/40例,P<0.05)。试验组1,2,3年的生存率分别为87.50%(35/40例),72.50%(29/40例),42.50%(17/40例),对照组1,2,3年的生存率分别为50.00%(20/40例),32.50%(13/40例),7.50%(3/40例),2组差异有统计学意义(P<0.05)。药物不良反应主要表现为中性粒细胞减少、手足反应综合征和恶心呕吐,试验组药物不良反应发生率为15.00%(6/40例),对照组为72.50%(29/40例,P<0.05)。结论由于高、中分化结直肠癌和低分化结直肠癌的病理特点有所不同,临床上对不同分化期的治疗应采取不同的治疗方式,以达到最有效的治疗方式。
Objective To observe the difference of clinical efficacy between XELOX regimen and poorly differentiated colorectal adenocarcinoma and high school differentiated colorectal adenocarcinoma. Methods Eighty patients with colorectal adenocarcinoma were divided into control group of 40 cases (poorly differentiated colorectal adenocarcinoma) and experimental group of 40 cases (high and moderately differentiated colorectal adenocarcinoma). The patients in both groups were treated with XELOX regimen. On the first day, oxaliplatin 130 mg · m -2 was instilled intravenously for 3 h. On the 1st to 14th day, capecitabine 1000 mg · m ~ (-2), morning and evening 1, continuous medication for 2 weeks, 3 weeks for a course of treatment, a total of 3 courses of treatment. The changes of mRNA expression of ATF5 and Bcl-2 mRNA in two groups before and after treatment were observed. The clinical efficacy, adverse drug reactions The incidence of long-term survival was observed in two groups of patients. Results After treatment, the relative content of ATF5 mRNA in the experimental group was 0.43 ± 0.07, the relative content of Bcl -2 mRNA was 0.33 ± 0.04, the relative content of ATF5 mRNA in the control group was 1.52 ± 0.09, and the relative content of Bcl -2 mRNA was 0.78 ± 0.10, the difference was statistically significant (P <0.05). The total effective rate in the experimental group was 87.50% (35/40 cases), while that in the control group was 60.00% (24/40 cases, P <0.05). The survival rates at 1, 2 and 3 years in experimental group were 87.50% (35/40 cases), 72.50% (29/40 cases) and 42.50% (17/40 cases) in control group, respectively Rates were 50.00% (20/40 cases), 32.50% (13/40 cases) and 7.50% (3/40 cases), respectively. There was significant difference between the two groups (P <0.05). Adverse drug reactions mainly manifested as neutropenia, hand-foot reaction syndrome and nausea and vomiting, the incidence of adverse drug reactions in the test group was 15.00% (6/40 cases), the control group was 72.50% (29/40 cases, P < 0.05). Conclusion Due to the different pathological features of high and moderately differentiated colorectal cancer and poorly differentiated colorectal cancer, different treatment methods should be adopted for the treatment of different differentiation stages clinically in order to achieve the most effective treatment.