陈幸运　周礼鲲　王霞　白明　刘锐　李鸿立　巴一　黄鼎智



维持治疗在晚期结直肠癌化疗后达稳定患者中的价值及预后分析*

陈幸运周礼鲲王霞白明刘锐李鸿立巴一黄鼎智

摘要目的：探讨晚期结直肠癌姑息化疗后获得疾病稳定患者的预后异质性及个体化治疗策略的应用。方法：研究收集2008年4月至2014年10月204例在天津医科大学肿瘤医院接受标准一线和（或）二线化疗后获得疾病稳定的晚期结直肠癌患者，分析该人群临床病理特征，筛选预后异质性分层因子，并评估姑息化疗后治疗手段（即单纯观察或维持治疗）对于特殊人群的影响。结果：单因素生存分析表明化疗线数、基线CA724、CEA、CA19-9水平、血小板淋巴细胞比率（PLR）、姑息化疗后治疗手段为预后影响因素。多因素Cox比例风险回归模型分析显示，一线化疗、基线CA19-9低水平、PLR低水平、姑息化疗后维持治疗患者预后较好。亚组分析显示PLR高水平患者中，维持治疗组与观察组无进展生存期分别为13.43个月和10.63个月（P=0.003）。结论：基线CA19-9、PLR水平及姑息化疗后治疗手段为获得疾病稳定的晚期结直肠癌患者的独立预后因子。疾病稳定人群尤其是PLR高水平者宜接受维持治疗。

关键词晚期结直肠癌疾病稳定生存预后

*本文课题受国家自然科学基金项目（编号：81572321）和天津市科委应用基础面上项目（编号：15JCYBJC28200）资助

Analysis of the maintenance treatment and prognostic factors of metastatic colorectal cancer patients with stable disease symptoms after induction chemotherapy

Xingyun CHEN, Likun ZHOU, Xia WANG, Ming BAI, Rui LIU, Hongli LI, Yi BA, Dingzhi HUANG
Correspondence to: Dingzhi HUANG; E-mail: dingzhih72@163.com
Department of Gastrointestinal Medical Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
This work was supported by the National Natural Science Foundation of China（No.81572321）and the Applied Basic Research Program of Science and Technology Commission Foundation of Tianjin（No.15JCYBJC28200）

Abstract Objective: To investigate the survival and individualized therapy of metastatic colorectal cancer（mCRC）patients who achieved a stable disease state after induction chemotherapy.Methods: Data were reviewed from 204 metastatic colorectal cancer patients, who presented a stable disease state after first-line and second-line chemotherapy at Tianjin Medical University Cancer Institute and Hospital.The clinical and pathological characteristics were analyzed.Moreover, we analyzed the significance of maintenance treatment in patients with certain mCRC characteristics.Results: Univariate analysis indicated that the line of chemotherapy, levels of CA724, CEA, and CA19-9, and platelet-to-lymphocyte ratio（PLR）were considered prognostic factors of treatment after induction chemotherapy.According to the multivariate analysis, first-line chemotherapy, as well as low levels of CA19-9 and PLR, with maintenance treatment after the induction chemotherapy was significantly associated with better survival.Among the patients with high levels of PLR, those who underwent maintenance treatment achieved a progression-free survival of 13.43 months（versus 10.63 months in patients from the observation group, P=0.003）.Conclusion: The levels of CA19-9 and PLR, and treatment after chemotherapy were significant prognostic factors for mCRC patients who achieved a stable disease state after induction chemotherapy.These patients, especially those with high PLR, could benefit from the maintenance treatment.

Keywords:metastatic colorectal cancer, stable disease, survival, prognosis

随着治疗手段的进步，晚期结直肠癌的疾病控制率已得到显著提高，而姑息化疗获得疾病稳定的人群比例高达50%左右［1-2］。众多研究结果提示获得部分缓解和完全缓解的患者预后较好，但是对于具有不同生物学特征的治疗后稳定的人群研究并不充分。……