ABSTRACT
Objective To observe the clinical efficacy and safety of apatinib in the treatment of advanced malignant tumors and to analyze the prognostic indicators affecting the survival of patients.Methods A total of 100 patients with advanced malignant tumors who were treated with apatinib at Jinan Central Hospital Affiliated to Shandong University from February 2015 to July 2018 were enrolled and their data were analyzed retrospectively.The clinical efficacy was evaluated and the related adverse reactions were recorded.Single and multiple factor analyses were pefformed by Cox regression model.The predictive factors of progression-free survival (PFS) and overall survival (OS) were analyzed.Results One-hundred patients with advanced malignant tumors who were treated with second-line and above treatment were collected.All patients were assessable for response,no complete response was observed,22 patients (22％) achieved partial remission,58 patients (58％) in stable disease,and 20 patients (20％) appeared progressive disease.The objective response rate was 22％ (22/100),the disease control rate was 80％ (80/100),the median PFS was 3.6 months (95％ CI:2.7-4.5 months),and the median OS was 7.0 months (95％ CI:4.7-9.3 months).Univariate analysis showed that Eastern Cooperative Oncology Group (ECOG) score (HR =0.340,95％ CI:0.211-0.546,P ＜0.001),tumor primary site (HR =1.757,95％ CI:1.053-2.932,P =0.031),neutrophil to lymphocyte ratio (NLR) (HR =0.389,95％ CI:0.227-0.666,P =0.001),hemoglobin (HR =1.696,95％ CI:1.023-2.813,P =0.041) and proteinuria (HR =1.790,95％ CI:1.105-3.155,P =0.044) were related to PFS;age (HR =2.082,95 ％ CI:1.320-3.285,P =0.002),ECOG score (HR =0.206,95％ CI:0.123-0.344,P＜0.001),tumor primary site (HR=1.784,95％CI:1.077-2.954,P=0.025),NLR (HR=0.410,95％CI:0.238-0.704,P =0.001),hemoglobin (HR =1.958,95％ CI:1.175-3.264,P =0.010) and albumin (HR =0.467,95％ CI:0.277-0.787,P =0.004) were related with OS.Multivariate analysis showed that PFS was related to ECOG score (HR =0.254,95％ CI:0.123-0.523,P ＜ 0.001) and NLR (HR =0.378,95％CI:0.161-0.888,P =0.026),and OS was related to ECOG score (HR =0.147,95％ CI:0.067-0.326,P ＜0.001),NLR (HR =0.327,95％ CI:0.140-0.765,P =0.010) and hemoglobin (HR =1.975,95％ CI:1.101-3.543,P =0.022).In term of safety,the most common adverse events among 100 cases of treated patients with advanced malignant tumors were hypertension (53,53 ％),anorexia (51,51％),fatigue (51,51％) and anemia (50,50％),among which the most common ones of grade 3 and 4 were hypertension (10,10％),thrombocytopenia (8,8％),leukopenia (7,7％) and hand-foot syndrome (6,6％).Conclusion Apatinib has certain clinical efficacy and manageable adverse events in the treatment of advanced malignant tumors at and above second-line treatment.ECOG score and NLR are independent predictors of PFS and OS in patients with advanced malignant tumors treated with apatinib.
ABSTRACT
Objective:To evaluate the efficacy and safety of oxycodone combined with dexmedetomidine in the postoperative analgesia in the patients underwent laparoscopic radical surgery of colon cancer.Methods:Sixty colon cancer patients underwent laparoscopic radical surgery and recevied patient-controlled intravenous analgesia after operation were randomly divided into control group and experiment group (n=30)using The "Envelope Method". The patients in control group were given 0.5 mg·kg-1 oxycodone,and the patients in experiment group were given 0.5 mg·kg-1 oxycodone and 2 μg·kg-1 dexmedetomidine.The parameters of analgesic pump in two groups were set as follows:the continuous perfusion rate was 1 mL·h-1 ,the single bolus was 1.5 mL,the lock-out time was 10 min,and the total volume was 100 mL.The VAS scores of pain at rest and activity pain of the patients in two groups were evaluated at exiting the post anesthesia care unit (T1 ),and at 6 h (T2 ),12 h (T3 ),24 h (T4 )and 48 h (T5 )after operation.The dose of analgesic drugs used,times of emergent rescue analgesia and anus exhaust time after operation of the patients in two groups were recorded;the postoperative adverse responses,vital signs and Ramsay scores of the patients in two groups were observed.Results:The VAS scores of activity pain at T2 -T5 and pain at rest at T2 -T4 of the patients in experiment group (P T2-T5 =0.000;P T2 =0.018,P T3 =0.001,P T4 =0.010)were lower than those in control group;the doses of analgesic drugs used and times of emergent rescue analgesia of the patients in experiment group were significantly lower than those in control group (P =0.000,P =0.029);the anus exhaust time after operation was significantly earlier than that in control group (P =0.030);the cases of nausea of the patients in experiment group were significantly lower than that in control group (P =0.023), and there were no significantly differences in the other various adverse effects of the patients between two groups (P >0.05).Conclusion: Oxycodone combined with dexmedetomidine is effective and safe for the postoperative analgesia after laparoscopic radical surgery of colon cancer.