CAJ | 학술논문

目的：观察贝伐珠单抗（bevacizumab, Bev）联合化疗治疗复治转移性结直肠癌（mCRC）的疗效和不良反应。方法：回顾分析2010年1月－2013年12月在解放军总医院接受Bev联合化疗二线及以上治疗的mCRC 60例。采用实体肿瘤疗效评价标准（RECIST）1.0版评价疗效， Kaplan-Meier法进行生存分析。结果：60例mCRC，9例部分缓解(PR)，36例稳定(SD)，客观缓解率(ORR)为15%，疾病控制率（DCR）为75.0%。二线治疗的39例中PR 5例，SD 23例，ORR 12.8%，DCR 71.8%。三线治疗的28例中PR 4例，SD 16例，ORR 14.3%，DCR 71.4%。三线以上治疗的9例中PR 0例，SD 6例，DCR 66.7%。二线治疗的中位无进展生存期（mPFS）及总生存（mOS）分别为3.4月和10.2月；三线及三线以上治疗的mPFS分别为4.8月和2.8月，mOS分别为9.4月和10.9月。Bev相关不良反应包括蛋白尿、出血、高血压，均为1~2级。结论：Bev联合化疗三线及三线以上治疗mCRC展现了较好的疾病控制率及生存获益，且在初次Bev治疗进展后更改化疗方案继续使用Bev仍可临床获益。多线及后线应用Bev联合化疗并未增加不良反应发生率，不良反应可耐受其发生机制尚不明确，多种危险因素可使其发生风险增加，临床中应注意对高危患者的识别和管理。
목적：관찰패벌주단항（bevacizumab, Bev）연합화료치료복치전이성결직장암（mCRC）적료효화불량반응。방법：회고분석2010년1월－2013년12월재해방군총의원접수Bev연합화료이선급이상치료적mCRC 60례。채용실체종류료효평개표준（RECIST）1.0판평개료효， Kaplan-Meier법진행생존분석。결과：60례mCRC，9례부분완해(PR)，36례은정(SD)，객관완해솔(ORR)위15%，질병공제솔（DCR）위75.0%。이선치료적39례중PR 5례，SD 23례，ORR 12.8%，DCR 71.8%。삼선치료적28례중PR 4례，SD 16례，ORR 14.3%，DCR 71.4%。삼선이상치료적9례중PR 0례，SD 6례，DCR 66.7%。이선치료적중위무진전생존기（mPFS）급총생존（mOS）분별위3.4월화10.2월；삼선급삼선이상치료적mPFS분별위4.8월화2.8월，mOS분별위9.4월화10.9월。Bev상관불량반응포괄단백뇨、출혈、고혈압，균위1~2급。결론：Bev연합화료삼선급삼선이상치료mCRC전현료교호적질병공제솔급생존획익，차재초차Bev치료진전후경개화료방안계속사용Bev잉가림상획익。다선급후선응용Bev연합화료병미증가불량반응발생솔，불량반응가내수기발생궤제상불명학，다충위험인소가사기발생풍험증가，림상중응주의대고위환자적식별화관리。
Objective:To investigate the efficacy and toxicity of bevacizumab combined with chemotherapy for patients with refractory metastatic colorectal cancer (mCRC) as second- or later-line treatment.Methods: Sixty patients with mCRC treated by bevacizumab combined with chemotherapy in the PLA General Hospital from January 2010 to December 2013 were retrospectively analyzed with their overal response rate(RR), disease control rate(DCR), progression-free survival(PFS) and overal survival(OS). The tumor responses were assessed by response evaluation criteria in solid tumors guidelines (RECIST) version1.1. The adverse reactions were evaluated by common terminology criteria for adverse events version 3.0. The survival analysis was made by Kaplan-Meier method.Results:Of 60 patients with mCRC, 9 patients achieved partial response(PR) and 36 patients had stable disease(SD),exhibited an RR of 15.0%, and a DCR of 75.0%.Of 39 mCRC patients in second-line treatment by chemotherapy combined with bevacizumab, PR: 5, SD:23 patients, ORR:12.8% and DCR:71.8%. In the third-line treatment, 4 of 28 patients were PR, 16 patients were SD, ORR:14.3%, DCR: 71.4%. In the later-line treatment, there was no PR, just 6 patients were SD, DCR: 66.7%. The median DFS and OS in the second-line treatment were 3.4 and 10.2 months respectively. In the third- and later-line treatment, the median DFS were 4.8 and 2.8 months respectively, the median OS were 9.4 and 10.9 months, respectively. The adverse events related to bevacizumab included proteinuria, hemorrhage and hypertension, which were mostly in grade l-2 and aleviated with drug treatment.Conclusion:The efifcacy of Bevacizumab in combination with chemotherapy as second-line therapy for mCRC has not been improved signiifcantly, but the use of bevacizumab in the three line and three line above treatment can obtain better disease control rate and survival beneift. Patients who received bevacizumab combined with chemotherapy at the ifrst time can achieve beneift by changing chemotherapy regimen only after PD. Multi-line and the later-line application of bevacizumab in combination with chemotherapy did not increase the incidence of adverse reactions, and the toxicity can be wel tolerated in patients with mCRC.