摘要
目的观察曲妥珠单抗联合替吉奥治疗人类表皮生长因子受体2 (HER2)阳性ⅢB-Ⅳ期老年胃癌的临床效果及对磷脂酰肌醇3激酶(PI3K)/丝苏氨酸蛋白激酶(AKT)/哺乳动物雷帕霉素靶体蛋白(mTOR)信号传导通路的影响,为治疗胃癌提供方法。方法选择2014年6月~2019年6月在内蒙古民族大学附属呼伦贝尔市人民医院确诊并收治的HER2阳性ⅢB-Ⅳ期胃癌患者404例,随机分成观察组(n=202)与对照组(n=202)。对照组予以顺铂联合替吉奥治疗,观察组予以曲妥珠单抗联合替吉奥治疗。观察并比较2组临床疗效、不良反应、2年总生存率及外周血中癌胚抗原(CEA)、糖类抗原72-4 (CA72-4)、糖类抗原19-9 (CA19-9)和PI3K、AKT和mTOR mRNA水平。结果观察组患者的RR率及DCR率均明显高于对照组(P<0.05);治疗后,2组血清CA72-4、CEA、CA19-9、PI3K、AKT和mTOR mRNA水平较同组治疗前明显降低(P<0.05),且观察组均明显低于对照组(P<0.05);观察组患者2年总生存率高于对照组(P<0.05);观察组患者乏力、消化道反应、骨髓抑制、肝功异常发生率均明显低于对照组(P<0.05)。结论曲妥珠单抗联合替吉奥可有效治疗HER2阳性ⅢB-Ⅳ期胃癌,能够减少肿瘤标志物血清水平,提高患者生存率,下调PI3K/AKT/mTOR信号传导通路水平,且不良反应较少,具有一定临床价值。
Objective To observe the clinical effect of trastuzumab combined with tegafur on the human epidermal growth factor receptor 2(HER2)positive stageⅢB-Ⅳgastric cancer in elderly patients and its effect on phosphatidylinositol 3 kinase(PI3K)/serine protein kinase(AKT)/mammalian rapamycin target protein(mTOR)signal transduction pathway,so as to provide a method for the treatment of the disease.Methods 404 elderly patients with HER2 positive stageⅢB-Ⅳgastric cancer diagnosed and treated in Hulunbeir People's Hospital Affiliated to Inner Mongolia University for Nationalities from June 2014 to June 2019 were selected and randomly divided into observation group(n=202)and control group(n=202).The control group was treated with cisplatin combined with tegafur,and the observation group was treated with trastuzumab combined with tegafur.The clinical efficacy,adverse reactions,2-year overall survival rate,and the level of carcinoembryonic antigen(CEA),carbohydrate antigen 72-4(CA72-4),carbohydrate antigen 19-9(CA19-9)in peripheral blood,as well as the mRNA expression levels of PI3K,AKT and mTOR were observed and compared between the two groups.Results The response rate(RR)and disease control rate(DCR)of the observation group were significantly higher than those of the:control group(P<0.05).After treatment,the serum level of CA72-4,CEA,CA19-9,and the mRNA expression levels of PI3K,AKT and mTOR of the two groups were significantly lower than those of the same group before treatment(P<0.05),while the levels of above indexes of the observation group were significantly lower than those of the control group(P<0.05).The 2-year overall survival rate of the observation group was significantly higher than that of the control group(P<0.05)..The incidence of adverse reactions including fatigue,gastrointestinal reaction,myelosuppression and abnormal liver function in the observation group were lower than those in the control group(P<0.05).Conclusion Trastuzumab combined with tegafur can effectively treat HER2 positive stageⅢB-Ⅳgastric cancer,reduce the serum level of tumor markers,improve the survival rate of patients,down regulate the level of PI3K/AKT/mTOR signal transduction pathway,and have less adverse reactions.It has certain clinical value.
作者
谢耀莹
杨帆
李淑云
汪文娟
Xie Yaoying;Yang Fan;Li Shuyun;Wang Wenjuan(Department of Gastroenterology,Hulunbeir People's Hospital Affiliated to Inner Mongolia University for Nationalities,Hulunbuir,Inner Mongolia,021008,P.R.China;Department of Endocrinology,Health Management Center,Affiliated Hosptital of Inner Mongolia Universityfor Nationalities,Tongliao,Inner Mongolia,028007,P.R.China;Department ofGastroenterology,Shanghai Ninth People's Hospital Afiliated to Medical College of Shanghai Jiaotong University,Shanghai,200011,P.R.China)
出处
《老年医学与保健》
CAS
2021年第5期929-933,共5页
Geriatrics & Health Care
基金
呼伦贝尔市人民医院科研项目(H20190421)
