夏峰

【摘要】 目的：探讨阿帕替尼对二线化疗失败的晚期甲胎蛋白（alpha fetoprotein，AFP）阳性胃癌患者预后的影响。方法：回顾性分析2015年1月-2019年9月于本院治疗的60例晚期AFP阳性胃癌患者病例资料，根据治疗方法将其分为对照组与观察组，每组30例。对照组给予支持治疗，观察组在对照组患者治疗方法基础上给予阿帕替尼，对治疗效果进行比较。结果：观察组治疗总有效率和疾病控制率均优于对照组，差异均有统计学意义（P<0.05）。两组各不良反应发生情况比较，差异均无统计学意义（P>0.05）。治疗后，两组CEA、CA199均降低，且观察组均低于对照组，差异均有统计学意义（P<0.05）。对照组总生存时间中位数为4.669个月，观察组为7.834个月，差异有统计学意义（P<0.05）。结论：对二线化疗失败的晚期甲胎蛋白阳性胃癌患者使用阿帕替尼，能改善治疗效果，延长生存时间，值得在临床工作中使用。

【关键词】 阿帕替尼 二线化疗 甲胎蛋白 胃癌

[Abstract] Objective： To investigate the effect of Apatinib on the prognosis of patients with advanced alpha-fetoprotein-positive （AFP） gastric cancer who failed second-line chemotherapy. Method： Retrospective analysis was performed on the data of 60 patients with advanced AFP positive gastric cancer treated from January 2015 to September 2019， according to the treatment methods， the patients were divided into control group and observation group， 30 cases in each group. The control group was given supportive treatment， the observation group was given Apatinib based on the treatment of the control group， the treatment effects of two groups were compared. Result： The total effective rate and disease control rate of the observation group were better than those of the control group， the differences were statistically significant （P<0.05）. There were no statistically significant differences in the occurrence of adverse reactions between two groups （P>0.05）. After treatment， CEA， CA199 in both groups were decreased， the observation group were lower than those in the control group， with statistically significant differences （P<0.05）. The median total survival time was 4.669 months in the control group and 7.834 months in the observation group， the difference was statistically significant （P<0.05）. Conclusion： Appatinib can improve the therapeutic effect and prolong the survival time of patients with advanced AFP-positive gastric cancer who failed second-line chemotherapy. It is worth using in clinical work.

[Key words] Apatinib Second-line chemotherapy Alpha fetoprotein Gastric cancer

First-authors address： Beizhen Peoples Hospital， Beizhen 121300， China

doi：10.3969/j.issn.1674-4985.2021.03.029

在全球范圍内胃癌的年发病率在所有恶性肿瘤中排名第五，在癌症导致的死亡原因排名中位居第三[1-2]。目前对该种疾病的治疗方法有若干，部分患者甚至可以通过彻底的外科切除手术与放化疗辅助获得较理想的生存时间和生存质量[3]。含铂类药物联合使用作为一线化疗方案的方法可以使多数胃癌患者受益[4]。但晚期胃癌患者的病情比较复杂，接受一线或者二线化疗后，效果较差。特别是甲胎蛋白（alpha fetoprotein，AFP）阳性的胃癌患者，其恶性程度更高，预后差。研究结果显示，对于晚期AFP阳性胃癌患者的化疗受益已经达到极限[5-6]。近些年来的研究认为血管内皮生长因子与该因子受体-2所介导的信号传导与血管形成是胃癌的重要发病机制[7]。针对该种机制所开发出的靶向治疗药物成为患者的福音。选择在本院进行治疗的晚期AFP阳性胃癌患者60例的资料进行分析，现报道如下。……