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目的:探讨结直肠癌患者行FOLFOX6方案化疗后5-氟尿嘧啶(5-FU)稳态血药浓度(Css)与疗效及不良反应的相关性和临床意义。方法:收集接受FOLFOX6方案化疗的晚期结直肠癌患者共48例,采用高效液相色谱(HPLC)法检测结直肠癌患者外周血5-FUCss,分析5-FUCss与不良反应、缓解率的关系。结果:5-FUCss在48例结直肠癌患者中不呈正态分布,范围153.7～1094.8μg/L,平均(400.0±190.2)μg/L,个体之间变异较大。随着结直肠癌患者Css的升高,骨髓抑制、口腔黏膜炎及腹泻等不良反应的发生率明显增加,P<0.05。化疗有效患者的平均Css为(469.9±210.8)μg/L,明显高于疾病稳定和进展的患者〔(384.4±127.1)和(257.9±104.2)μg/L〕,P<0.05。结论:结直肠癌患者化疗时Css在300～600μg/L时将获得最佳的疗效和最小的不良反应。
Objective: To investigate the correlation and clinical significance of 5-fluorouracil (5-FU) steady-state plasma concentration (Css) and efficacy and side effects in patients with colorectal cancer after FOLFOX6 regimen. Methods: Forty-eight patients with advanced colorectal cancer who underwent chemotherapy with FOLFOX6 regimen were enrolled. The 5-FUCss in peripheral blood of patients with colorectal cancer was detected by high performance liquid chromatography (HPLC). The relationship between 5-FUCss and adverse reaction and remission rate was analyzed. Results: The 5-FUCss did not show a normal distribution in 48 patients with colorectal cancer, ranging from 153.7 to 1094.8 μg / L, with an average of (400.0 ± 190.2) μg / L, with a large variation among individuals. With the increase of Css in patients with colorectal cancer, the incidence of bone marrow suppression, oral mucositis and diarrhea and other adverse reactions increased significantly, P <0.05. The mean Css of chemotherapy-effective patients was (469.9 ± 210.8) μg / L, significantly higher than that of patients with stable and advanced disease (384.4 ± 127.1 and 257.9 ± 104.2 μg / L, P <0.05). CONCLUSIONS: When Css is administered from 300 to 600 μg / L in patients with colorectal cancer, the best efficacy and minimal adverse reactions will be obtained.