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目的:探讨经手术切除的ⅢB及ⅢC期结直肠癌患者术后辅助化疗联合免疫治疗的疗效。方法:选择经手术切除的ⅢB期及ⅢC期结直肠癌患者31例(联合治疗组),采用XELOX方案(第1天静脉滴注奥沙利铂,130 mg/m2;第1~14天口服卡培他滨,1 000 mg/m2,2次/d,21 d为1个周期)术后辅助化疗,序贯免疫治疗[第2~5天粒细胞-巨噬细胞集落刺激因子(GM-CSF)150μg皮下注射,第6~19天IL-2 100万IU皮下注射,21 d为1个周期],6~8个周期。选择同期经手术切除的ⅢB期及ⅢC期结直肠癌患者21例(单纯化疗组),采用XELOX方案术后辅助化疗。比较两组患者治疗前后免疫功能的变化;密切随访,计算无病生存时间(disease-free survival,DFS);记录治疗相关不良事件。结果:所有患者均可评价免疫功能及毒副反应。联合治疗组治疗后CD8+T细胞比例较治疗前明显降低(P<0.05);与单纯化疗组相比,联合治疗组治疗后CD8+T细胞比例明显降低(P<0.05),NK细胞比例、CD4+/CD8+比值明显增高(P<0.05)。联合治疗组和单纯化疗组中位DFS分别为23.17月和14.62月。两组毒副反应均以消化道反应和血液学毒性为主,无严重毒副反应发生,经对症治疗后均可恢复正常。两组患者均未发生治疗相关性临床死亡事件。结论:标准术后辅助化疗联合序贯免疫治疗可进一步延长ⅢB及ⅢC期结直肠癌患者术后DFS,提高其免疫功能,且患者依从性良好。
Objective: To investigate the effect of postoperative adjuvant chemotherapy and immunotherapy in patients with stage ⅢB and ⅢC colorectal cancer who underwent resection. METHODS: Totally 31 patients with stage ⅢB and ⅢC colorectal cancer who underwent resection were selected and treated with XELOX regimen (oxaliplatin, 130 mg / m 2 on the first day, orally Capecitabine, 1 000 mg / m2, 2 times / d, 21 days for 1 cycle) adjuvant postoperative adjuvant chemotherapy, sequential immunotherapy [Day2-5 day GM- CSF) 150μg subcutaneously on the 6th to 19th day IL-2 1000000 IU subcutaneous injection, 21d for a cycle], 6 to 8 cycles. 21 patients with stage ⅢB and ⅢC colorectal cancer who underwent surgical resection during the same period (chemotherapy alone group) were treated with adjuvant chemotherapy with XELOX regimen. The changes of immune function in both groups before and after treatment were compared. Close follow-up was used to calculate the disease-free survival (DFS). The treatment-related adverse events were recorded. Results: All patients were evaluated for immune function and toxicity. Compared with the chemotherapy alone group, the proportion of CD8 + T cells in the combined treatment group was significantly decreased (P <0.05), the proportion of NK cells, CD4 + / CD8 + ratio was significantly higher (P <0.05). Median DFS in the combination and chemotherapy groups was 23.17 months and 14.62 months, respectively. Two groups of side effects are gastrointestinal reactions and hematological toxicity, no serious side effects, after symptomatic treatment can return to normal. No treatment-related clinical death occurred in either group. CONCLUSIONS: Standard postoperative adjuvant chemotherapy combined with sequential immunotherapy can further prolong postoperative DFS and improve immune function in patients with stage ⅢB and ⅢC colorectal cancer, and the patient’s compliance is good.