CAJ | 학술논문

目的：评价晚期结直肠癌患者联合化疗后卡培他滨维持治疗的临床疗效、安全性、可行性。方法采用回顾性研究方法，分析我科2009年5月~2012年12月住院治疗的73例晚期结直肠癌连续病例，均采用含氟尿嘧啶类联合奥沙利铂或伊立替康化疗。肿瘤达到化疗最大缩小率后，其中42例给予单药卡培他滨1000 mg/m2 bid*14 d/3周的维持治疗至不能耐受或进展；另31例停止化疗随访观察。使用Kaplan-Meier分析两组的疗效，χ2检验分析安全性。结果卡培他滨维持治疗的42例中位PFS为11.6月（95%CI：10.22~11.78），联合化疗的有效率（RR）：42.8%。31例停止化疗病例对照观察中位PFS为7.4月（95%CI：5.79~8.21），联合化疗的RR：38.7%。两组RR相似但PFS疗效有统计学差异（P<0.01）。联合化疗时大多数所有级别的不良反应进入维持或停药观察后都有明显减少，两组分别与强烈化疗时对比血液或非血液不良反应差异有统计学意义（P<0.05），而两组不良反应之间除手足综合征外无统计学差异（P>0.05）。结论通过卡培他滨维持治疗的晚期结直肠癌患者得到较长的PFS，且耐受性好，保留了再次进展后接受强烈化疗的可能性，为提高晚期结直肠癌患者生存获益和生活质量提供基础，同时提供了一种有效并有良好耐受性的治疗模式，具有进一步研究探索的可行性和临床前景。
목적：평개만기결직장암환자연합화료후잡배타빈유지치료적림상료효、안전성、가행성。방법채용회고성연구방법，분석아과2009년5월~2012년12월주원치료적73례만기결직장암련속병례，균채용함불뇨밀정류연합오사리박혹이립체강화료。종류체도화료최대축소솔후，기중42례급여단약잡배타빈1000 mg/m2 bid*14 d/3주적유지치료지불능내수혹진전；령31례정지화료수방관찰。사용Kaplan-Meier분석량조적료효，χ2검험분석안전성。결과잡배타빈유지치료적42례중위PFS위11.6월（95%CI：10.22~11.78），연합화료적유효솔（RR）：42.8%。31례정지화료병례대조관찰중위PFS위7.4월（95%CI：5.79~8.21），연합화료적RR：38.7%。량조RR상사단PFS료효유통계학차이（P<0.01）。연합화료시대다수소유급별적불량반응진입유지혹정약관찰후도유명현감소，량조분별여강렬화료시대비혈액혹비혈액불량반응차이유통계학의의（P<0.05），이량조불량반응지간제수족종합정외무통계학차이（P>0.05）。결론통과잡배타빈유지치료적만기결직장암환자득도교장적PFS，차내수성호，보류료재차진전후접수강렬화료적가능성，위제고만기결직장암환자생존획익화생활질량제공기출，동시제공료일충유효병유량호내수성적치료모식，구유진일보연구탐색적가행성화림상전경。
Objective To evaluate efficacy, safety, and feasibility of maintenance therapy with capecitabine after fluoropyrimidines/oxaliplatin or fluoropyrimidines/irinotecan chemotherapy in patients with incurable colorectal cancer. Methods Seventy-three hospitalized patients with incurable colorectal cancer who received fluoropyrimidines/oxaliplatin or fluoropyrimidines/irinotecan as the first-line chemotherapy between May 2009 and December 2012 in our department were retrospectively analyzed. When the maximum percentage tumor size reduction was achieved, 42 patients received a maintenance therapy with capecitabine at 1000 mg/m2 in two daily doses on days 1-14, and the other 31 patients without further chemotherapy or the maintenance therapy were followed up. The treatment was repeated every 3 weeks as a cycle until disease progression or intolerable toxicity. The efficacy and safety were evaluated by Kaplan-Meier analysis and χ2 analysis. Results The 42 patients receiving capecitabine maintenance therapy achieved a median progression free survival (PFS) of 11.6 months (95%CI 7.8-15.4), significantly longer than the PFS of 7.4 months (95% CI 4.9-11.8) in the 31 patients without the maintenance therapy (P<0.01). The response rate (RR) after combined chemotherapy in the two groups were similar (42.8% vs 38.7%). χ2 analysis indicated significant reductions in the adverse reactions (P<0.05) in both groups after therapy without significant differences between the two groups (P>0.05) except for hand-foot syndrome. Conclusion In patients with incurable colorectal cancer, capecitabine maintenance therapy following combined chemotherapy can achieve a prolonged PFS with a good safety and tolerance and retains the possibility of further intense therapy in the event of disease progression.