龚玉芳++刘峰+++杨志胤++姜斌

[摘要] 目的 探討新辅助化疗治疗非小细胞肺癌患者的效果，并分析其对患者治疗前后血清糖类抗原125（CA125）、癌胚抗原（CEA）及细胞角蛋白19片段抗原（CYFRA21-1）水平的影响。 方法 选取2009年7月～2010年10月上海交通大学医学院附属第九人民医院收治的非小细胞肺癌患者136例，按随机数字表法将入选患者分为观察组和对照组，每组68例。两组均行手术根治术治疗，其中观察组加用GP方案新辅助化疗，对照组则未行GP方案新辅助化疗。比较分析两组临床近期疗效、不良反应、生存率，以及治疗前后CA125、CEA及CYFRA21-1水平变化。 结果 观察组患者治疗总有效率为69.1%，明显高于对照组（38.2%）（P < 0.05）。治疗前，两组CA125、CEA及CYFRA21-1水平比较，差异均无统计学意义（P > 0.05）；治疗后，观察组CA125、CEA及CYFRA21-1水平均明显低于对照组（P < 0.05）。观察组不良反应发生率为7.4%，明显低于对照组（14.7%）（P < 0.05）。观察组3、5年生存率均明显高于对照组（P < 0.05）。 结论 GP方案新辅助化疗用于非小细胞肺癌患者的临床治疗具有较高的应用价值，可降低患者血清CA125、CEA及CYFRA21-1水平，提高其预后，不良反应少，值得应用及推广。

[关键词] 新辅助化疗；非小细胞肺癌；吉西他滨

[中图分类号] R734.2 [文献标识码] A [文章编号] 1673-7210（2017）04（b）-0091-04

[Abstract] Objective To discuss the clinical effect of preoperative neoadjuvant chemotherapy in the treatment of patients with non-small cell lung cancer （NSCLC）， and to analyze the effects of it on the levels of serum carbohydrate antigen 125 （CA125）， carcinoembryonic antigen （CEA） and cytokeratin 19 fragment antigen （CYFRA21-1） before and after treatment. Methods One hundred and thirty-six patients with NSCLC admitted to Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from July 2009 to October 2010 were selected， and the enrolled patients were randomly divided into observation group and control group by random number table method， with 68 cases in each group. Both groups were treated with radical surgery， the observation group was treated with GP regimen neoadjuvant chemotherapy， while the control group did not receive neoadjuvant chemotherapy with GP regimen. The clinical efficacy， adverse reactions， survival rate， and the changes of CA125， CEA and CYFRA21-1 levels before and after treatment in the two groups were compared and analyzed. Results The total effective rate of the observation group was 69.1%， which was significantly higher than that of the control group （38.2%） （P < 0.05）. Before treatment， the levels of CA125， CEA and CYFRA21-1 between the two groups had no statistically significant differences （P > 0.05）； after treatment， the levels of CA125， CEA and CYFRA21-1 in the observation group were significantly lower than those of control group （P < 0.05）. The incidence of adverse reactions in the observation group was 7.4%， which was significantly lower than that of the control group （14.7%） （P < 0.05）. The 3-year and 5-year survival rates of the observation group were significantly higher than those of the control group （P < 0.05）. Conclusion Application of neoadjuvant chemotherapy with GP regimen for the clinical treatment of patients with NSCLC has relatively high value， which can decrease the levels of CA125， CEA and CYFRA21-1 of patients， improve the prognosis， with less adverse reactions， it is worthy of application and promotion.

[Key words] Neoadjuvant chemotherapy； Non small cell lung cancer； Gemcitabine

非小细胞肺癌是一种比较常见的肺癌，此病发病比较隐匿，确诊时往往处于中晚期[1]。非小细胞肺癌恶性程度比较高，病死率也高，缺少早诊断的有效方法。目前，手术根治法是治疗非小细胞肺癌的主要方法，但是手术疗法存在术中癌细胞播散、复发率高与预后不佳等缺陷[2-3]。为此，有必要积极寻找高效的非小细胞肺癌治疗方案。近些年来，许多学者对如何提升非小细胞肺癌患者预后做了比较多的探索，研究发现通过新辅助化疗可以降低术后复发率及提高预后[4-6]。GP方案新辅助化疗是一种以静脉滴注250 mL生理盐水+1000 mg/m2吉西他滨（第1、8天）；静脉滴注500 mL生理盐水+30 mg/m2顺铂（第1～3天）为主的治疗方案。……