CAJ | 학술논문

目的：探讨两种不同类型靶向药物在不同给药模式下对转移性结直肠癌（ mCRC）患者生存的影响。方法回顾性分析135例接受过分子靶向治疗mCRC患者的临床病理特征、靶向治疗情况及随访资料，比较不同种类靶向药物及不同线数化疗联合靶向治疗对生存期（ OS）的影响。结果全组中接受抗EGFR单抗者、接受贝伐珠单抗者及接受抗EGFR单抗＋贝伐珠单抗者的中位OS依次为20?7、24?4和41?6个月，接受两种靶向药物者比仅接受一种靶向药物者的中位OS有明显延长（ P＜0?05）；一线化疗未联合靶向治疗者的中位OS为30?8个月，与一线化疗联合靶向治疗者的21?5个月相比，差异无统计学意义（ P＞0?05）；三线及以上联合靶向治疗者的中位OS为37?0个月，高于三线前均联合靶向治疗者的13?7个月，差异有统计学意义（ P＜0?05）；接受过三种化疗药物（伊立替康、奥沙利铂、氟尿嘧啶）及贝伐珠单抗和抗EGFR单抗两种靶向药物的患者中，三线及以上使用靶向者的中位OS为50?6个月，与三线前使用靶向者的41?6个月比较，差异无统计学意义（ P＞0?05）。结论接受过两类靶向药物治疗的mCRC患者比仅接受一类靶向药物者可能获得更好生存获益。患者使用靶向药物的时机并非越早越好，肿瘤生物学行为较好的患者更适合先化疗后靶向的治疗模式。
목적：탐토량충불동류형파향약물재불동급약모식하대전이성결직장암（ mCRC）환자생존적영향。방법회고성분석135례접수과분자파향치료mCRC환자적림상병리특정、파향치료정황급수방자료，비교불동충류파향약물급불동선수화료연합파향치료대생존기（ OS）적영향。결과전조중접수항EGFR단항자、접수패벌주단항자급접수항EGFR단항＋패벌주단항자적중위OS의차위20?7、24?4화41?6개월，접수량충파향약물자비부접수일충파향약물자적중위OS유명현연장（ P＜0?05）；일선화료미연합파향치료자적중위OS위30?8개월，여일선화료연합파향치료자적21?5개월상비，차이무통계학의의（ P＞0?05）；삼선급이상연합파향치료자적중위OS위37?0개월，고우삼선전균연합파향치료자적13?7개월，차이유통계학의의（ P＜0?05）；접수과삼충화료약물（이립체강、오사리박、불뇨밀정）급패벌주단항화항EGFR단항량충파향약물적환자중，삼선급이상사용파향자적중위OS위50?6개월，여삼선전사용파향자적41?6개월비교，차이무통계학의의（ P＞0?05）。결론접수과량류파향약물치료적mCRC환자비부접수일류파향약물자가능획득경호생존획익。환자사용파향약물적시궤병비월조월호，종류생물학행위교호적환자경괄합선화료후파향적치료모식。
Objective To explore the influence of anti-VEGF monoclonal antibody and anti-EGFR monoclonal antibody on survival of patients with metastatic colorectal cancer ( mCRC) under different administration patterns. Methods In a retrospective study, the clinical characteristics, targeted therapy and follow-up data were analyzed among 135 mCRC patients ever treated with mo-lecular targeted therapies. The medium overall survival( OS) was compared among different kinds of targeted drugs and different lines of chemotherapy plus targeted therapy. Results Among mCRC patients, the medium OS for patients receiving anti-EGFR monoclonal an-tibody, bevacizumab or anti-EGFR monoclonal antibody plus bevacizumab were 20?7, 24?4 and 41?6 months, respectively. The medi-um OS was significantly longer in mCRC patients receiving anti-EGFR monoclonal antibody plus bevacizumab than anti-EGFR mono-clonal antibody or bevacizumab alone(P<0?05). The medium OS for patients receiving chemotherapy alone as first-line treatment or first-line chemotherapy plus molecular targeted therapies were 30?8 and 21?5 months, respectively( P>0?05) . The medium OS for pa-tients receiving monoclonal antibody after second-line therapy was 37?0 months, higher than 13?7 months for patients receiving chemo-therapy plus monoclonal antibody therapy for either first-line or second-line option with significant difference( P<0?05) . Among patients ever treated with irinotecan, oxaliplatin, fluorouracil, anti-EGFR monoclonal antibody and bevacizumab, the medium OS for patients receiving chemotherapy plus monoclonal antibody used after third-line therapy was 50?6 months, similar with the 41?6 months for pa-tients receiving chemotherapy plus monoclonal antibody used before third-line therapy( P>0?05) . Conclusion Patients ever receiving both bevacizumab and anti-EGFR monoclonal antibody therapies had better survival than those who received either bevacizumab or anti-EGFR monoclonal antibody therapy. Earlier introduction of monoclonal antibody might not associate with better survival. Patients with good tumor biological behavior might benefit from the treatment pattern of chemotherapy before monoclonal antibody.