摘要
目的 探讨健脾消癌汤联合FOLFIRI方案化疗治疗脾肾亏虚证晚期结肠癌患者的临床效果及对其血清Friend白血病整合素1转录因子(Friend leukemia integration 1,FLI-1)/Klotho信号通路的影响。方法 选取2019年10月—2021年10月期间上海中医药大学附属市中医医院肿瘤三科收治的晚期结肠癌患者140例,采用随机数字表法分为对照组和观察组,每组各70例。对照组给予FOLFIRI方案化疗,观察组在对照组基础上加服健脾消癌汤治疗。以14 d为1个周期,治疗3个周期。观察比较两组患者近期疗效、不良反应情况,治疗前后中医症状评分、生活质量[卡氏功能状态(Karnofsky performance status,KPS)和生活质量评分(Quality of life,QOL)]、血清肿瘤标志物[癌胚抗原(Carcinoembryonic antigen,CEA)、糖类抗原(Carbohydrate antigen,CA)199和细胞角蛋白19片段(Cytokeratin19 fragmentantigen 21-1,CYFRA21-1)]、血管生成因子[血管内皮生长因子(Vascular endothelial growth factor,VEGF)、碱性成纤维细胞生长因子(Basic fibroblast growth factor,bFGF)和血小板衍生生长因子(Platelet derived growth factor,PDGF)]、FLI-1和Klotho mRNA表达量及无进展生存期(Progression free survival,PFS)。结果 治疗后观察组客观有效率42.86%(30/70)、疾病控制81.43%(57/70)均明显高于对照组17.14%(12/70)、51.43%(36/70),差异有统计学意义(P<0.05)。治疗后两组患者中医症状评分均较治疗前降低,差异有统计学意义(P<0.05);且观察组中医症状评分明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者KPS和QOL评分均较治疗前升高,差异有统计学意义(P<0.05);且观察组KPS和QOL评分均明显高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者血清CEA、CA199和CYFRA21-1均较治疗前降低,差异有统计学意义(P<0.05);且观察组血清CEA、CA199和CYFRA21-1均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者血清VEGF、bFGF和PDGF水平均较治疗前降低,差异有统计学意义(P<0.05);且观察组血清VEGF、bFGF和PDGF水平均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者血清FLI-1和Klotho mRNA表达量均较治疗前升高,差异有统计学意义(P<0.05);且观察组血清FLI-1和Klotho mRNA表达量均明显高于对照组,差异有统计学意义(P<0.05)。治疗期间,观察组Ⅰ~Ⅱ级白细胞减少、肝肾功能损伤和恶心呕吐发生率低于对照组,差异有统计学意义(P<0.05);血小板减少和神经毒性组间比较,差异无统计学意义(P>0.05)。观察组PFS中位数5.27个月明显优于对照组3.20个月,差异有统计学意义(Log-rank=20.216,P<0.05)。结论 健脾消癌汤联合FOLFIRI方案化疗治疗可提升晚期结肠癌近期疗效,减轻临床症状,改善生活质量,降低肿瘤标志物水平,减少肿瘤负荷,延长PFS,其机制可能与抑制血管生成因子表达,并调节FLI-1/Klotho信号通路的活化有关。
Objective To investigate the clinical effects of Jianpi Xiaoai Decoction combined with FOLFIRI regimen as chemotherapy in treating advanced colorectal cancer patients with spleen and kidney deficiency syndrome and its influence on the serum Friend leukemia integration 1(FLI-1)/Klotho signal pathway.Methods 140 patients with advanced colon cancer admitted into the Third Department of Oncology,Shanghai Municipal Hospital of Traditional Chinese Medicine,from October 2019 to October 2021 were selected and randomly divided into a control group and an observation group,with 70 patients in each group.The control group was treated with FOLFIRI regimen chemotherapy,while the observation group was treated with Jianpi Xiaoai decoction in addition to the FOLFIRI regimen.Each cycle lasted 14 days,and the treatment was administered for three cycles.The short-term efficacy,adverse reactions,symptom scores of spleen and kidney deficiency syndrome,quality of life[karnofsky performance status(KPS)and Quality of life(QOL)],serum tumor markers[carcinoembryonic antigen(CEA),carbohydrate antigen(CA)199,and cytokeratin19 fragment antigen 21-1(CYFRA21-1)],angiogenic factors[vascular endothelial growth factor(VEGF),basic fibroblast growth factor(bFGF),and platelet-derived growth factor(PDGF)],FLI-1 and Klotho mRNA expression levels and progression-free survival(PFS)were observed and compared between the two groups.Results After treatment,the objective response rate in the observation group was 42.86%(30/70)and the disease control rate was 81.43%(57/70),both significantly higher than those of the control group,which were 17.14%(12/70)and 51.43%(36/70),respectively,with statistical significance(P<0.05).Traditional Chinese medicine(TCM)symptom scores in both groups were lower after treatment compared to before treatment,with statistical significance(P<0.05);the TCM symptom scores in the observation group were significantly lower than those of the control group,with statistical significance(P < 0.05).KPS and QOL scores in both groups were higher after treatment compared to before treatment,with statistical significance(P<0.05);the scores of the observation group were significantly higher than those of the control group,with statistical significance(P<0.05).Serum levels of CEA,CA199,and CYFRA21-1 in both groups were lower after treatment compared to before treatment,with statistical significance(P<0.05);the CEA,CA199,and CYFRA21-1 levels of the observation group were significantly lower than those of the control group,with statistical significance(P<0.05).Serum levels of VEGF,bFGF,and PDGF in both groups were lower after treatment compared to before treatment,with statistical significance(P<0.05);the VEGF,bFGF,and PDGF levels of the observation group were significantly lower than those of the control group,with statistical significance(P<0.05).FLI-1 and Klotho mRNA expression levels in serum in both groups were higher after treatment compared to before treatment,with statistical significance(P<0.05);the FLI-1 and Klotho mRNA expression levels of the observation group were significantly higher than those of the control group,with statistical significance(P<0.05).During treatment,incidence rates of grade I-II leukopenia,liver and kidney function damage,and nausea and vomiting were lower in the observation group than in the control group,with statistical significance(P<0.05);there were no significant differences in thrombocytopenia and neurotoxicity between the groups(P>0.05).The median PFS in the observation group was 5.27 months,significantly longer than the control group′s 3.20 months,with statistical significance(Log-rank=20.216,P<0.05).Conclusion Jianpi Xiaoai Decoction combined with the FOLFIRI regimen chemotherapy can improve the short-term efficacy in treating advanced colorectal cancer,alleviate clinical symptoms,improve quality of life,lower tumor markers levels,reduce tumor load,and prolong PFS.Its mechanism may be related to the inhibition of angiogenic factor expression and the regulation of FLI-1/Klotho signaling pathway activation.
作者
杨伊
苏永华
贾嘉柠
石川
杜美璐
侯风刚
YANG Yi;SU Yong-hua;JIA Jia-ning;SHI chuan;DU Mei-lu;HOU Feng-gang(The Third Department of Oncology,Shanghai Municipal Hospital of Traditional Chinese Medicine,Shanghai 200071;Oncology Department,Yueyang Hospital of Integrated Traditional and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200000)
出处
《世界中西医结合杂志》
2024年第5期1005-1010,1015,共7页
World Journal of Integrated Traditional and Western Medicine
基金
国家自然科学基金资助项目(NSFC82174188)。
关键词
健脾消癌汤
结肠癌
脾肾亏虚证
肿瘤负荷
血管生成因子
Jianpi Xiaoai Decoction
Colon Cancer
Spleen and Kidney Deficiency Syndrome
Tumor Load
Angiogenic Factor
