ABSTRACT
Objective:To observe the short- and long-term efficacy of apatinib combined with chemoradiotherapy in the treatment of advanced gastric cancer and its effect on tumor markers.Methods:From January 2013 to January 2017, 84 patients with advanced gastric cancer admitted to the Department of Oncology of Chang′an Hospital of Xi′an City were selected as the subjects. The patients were divided into synchronous chemoradiotherapy group and targeted chemoradiotherapy group by prospective nested control method, with 42 cases in each group. The synchronous chemoradiotherapy group was treated with synchronous chemoradiotherapy, and the targeted chemoradiotherapy group was treated with apatinib combined with chemoradiotherapy, 2 weeks was a cycle, a total of 12 cycles. The short- and long-term efficacy, median overall survival, changes of gastric cancer-related markers and adverse reactions of the two groups were compared.Results:After 3 months of treatment, there was no significant difference in the efficacy distribution between the synchronous chemoradiotherapy group and the targeted chemoradiotherapy group ( Z=0.240, P=0.887). The disease control rates of the two groups were 69.05% (29/42) and 73.81% (31/42) respectively, with no statistically significant difference ( χ2=0.233, P=0.629). After 6 months of treatment, the difference of the efficacy distribution between the synchronous chemoradiotherapy group and the targeted chemoradiotherapy group was statistically significant ( Z=6.288, P=0.043), and the disease control rates of the two groups were 42.86% (18/42) and 69.05% (29/42) respectively, with a statistically significant difference ( χ2=5.845, P=0.016). The median overall survival in the targeted chemoradiotherapy group and synchronous chemoradiotherapy groups were 18.7 months (95% CI: 8.4-24.8) and 13.8 months (95% CI: 7.2-18.7), with a statistically significant difference ( χ2=7.542, P<0.001). After 3 months of treatment, the levels of carbohydrate antigen (CA) 19-9, CA125, carcino-embryonic antigen (CEA) were (16.27±2.13) U/ml, (13.25±2.26) U/ml, (2.97±0.85) ng/ml in the targeted chemoradiotherapy group and (29.34±3.69) U/ml, (21.63±2.69) U/ml, (6.19±1.23) ng/ml in the synchronous chemoradiotherapy group respectively, all of them were lower than those before treatment, and the CA19-9, CA125, CEA in the targeted chemoradiotherapy group were lower than those in the synchronous chemoradiotherapy group, and there were statistically significant differences ( t=19.880, P<0.001; t=15.458, P<0.001; t=13.957, P<0.001). The total incidence of grade 3-4 adverse reactions in the targeted chemoradiotherapy group was 23.81% (10/42) and 28.64% (12/42) in the synchronous chemoradiotherapy group, and there was no statistically significant difference ( χ2=0.186, P=0.667). Conclusion:The long-term efficacy of apatinib combined with chemoradiotherapy in the treatment of advanced gastric cancer is better than that of synchronous chemoradiotherapy, and it is safe and reliable. At the same time, it can prolong the overall survival and reduce the levels of serum tumor markers.
ABSTRACT
Objective To observe the clinical curative effet and survival condition of sorafenib for patients with advanced hepatocellular carcinoma.Methods Sixty-six patients with hepatocellular carcinoma during January 2013 to January 2015 in Chang'an Hospital were included.All patients were randomly divided into transcatheter arterial chemoembolization (TACE) group (n =33) and sorafenib + TACE group (n =33) according to the random digital table method.Followed up for 2 years,we observed the clinical curative effect,including 6-months survival rate,1-year survival rate,the changes of serum alpha fetoprotein level before and after the treatment,survival time and related adverse reactions.Results The disease control rate of sora-fenib + TACE group was 84.85％ (28/33),which was significantly higher than that of TACE group (60.61％,20/33),and the difference was statistically significant (x2 =4.889,P =0.027).The median survival time of patients with sorafenib +TACE group was 20.30 months,which was longer than that of TACE group (12.50 months),and the difference was statistically significant (x2 =29.570,P =0.000).The 6-months and 1-year survival rates in patients with sorafenib + TACE group were 93.93％ and 75.76％,respectively,which were significantly higher than those of TACE group (84.85％,51.52％).The rate of 1-year recurrence and metastasis of sorafenib + TACE group was 21.21％,which was lower than that of TACE group (39.39％),and the difference was statistically significant (x2 =2.908,P =0.041).After 6 months treatment,the serum level of alpha fetoprotein in patients with sorafenib + TACE group was (1 911.53 ± 457.86)ng/ml,which was signi-ficantly lower than that of TACE group [(2 979.83± 842.71)ng/ml],and the difference was statistically significant (t =11.996,P =0.001).The median survival time of patients with Child-Pugh A was significantly longer than that of patients with Child-Pugh B (20.50 months vs.13.95 months),with a significant difference (x2 =3.973,P =0.046).Patients in sorafenib + TACE group and TACE group had adverse reactions including nausea,vomiting and abnormal liver function,and there was significant difference in the incidence of untoward effects (87.88％ vs.60.61％;x2 =6.418,P =0.011).Conclusion The application of sorafenib the-rapy in the treatment of advanced hepatocellular carcinoma based on TACE can effectively improve the disease control rate,prolong the survival time of patients and improve the survival rate of patients.
ABSTRACT
Objective To explore the effect of fetal thymus transplantation on enhancing the immunity of patients with late-stage malignant tumors. Methods The whole thymus of 24～32 weeks fetus was transplanted into the forearm of the patients with late-stage milignant tumors by microvascular surgery. The levels of serum IgA,IgG and IgM were measured before and at the third, 6th and 12th months after operation. No immunosuppressive regimen was performed in all the patients after operation. The follow-up period was 1 to 2 years. Results The clinical symptoms of all the patients improved after treatment, and no rejection reaction occurred. The levels of serum IgA,IgG and IgM significantly increased 3,6 and 12 months after treatment(t≥4.23,P