本文選題：晚期食管鱗癌 + 沙利度胺��； 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：背景和目的食管癌是我國(guó)極為常見(jiàn)的惡性消化系統(tǒng)腫瘤之一,易侵犯其他組織器官,侵襲性強(qiáng),惡性程度非常高,預(yù)后極差。近些年來(lái)食管癌疾病的發(fā)生率在不斷上升,己逐步成為嚴(yán)重威脅人類(lèi)健康和生命的主要惡性疾病之一,在我國(guó)各種惡性腫瘤中,食管癌的發(fā)病率排在第六位,其死亡率居于第四位。食管癌的發(fā)病具有明顯的區(qū)域特征,中國(guó)也是食管癌的高發(fā)區(qū)之一,無(wú)論其發(fā)病率還是死亡率都居于我國(guó)惡性消化系統(tǒng)腫瘤的第三位,僅次于胃癌及肝癌。鱗狀細(xì)胞癌和腺癌是食管癌主要且有代表性的兩大組織學(xué)類(lèi)型,鱗狀細(xì)胞癌占據(jù)我國(guó)食管癌的大多數(shù),其發(fā)病的主要危險(xiǎn)因素是煙草和酒精。當(dāng)前食管癌的治療方式主要有手術(shù)、化療、放療,對(duì)其治療通常采用多模式綜合治療的手段,如果食管腫瘤能手術(shù)切除,且在患者可耐受的情況下,手術(shù)為其首要治療方式,因其初期即發(fā)生轉(zhuǎn)移和擴(kuò)散,多半患者在明確診斷時(shí)已經(jīng)處于晚期,錯(cuò)失了外科治療的最適時(shí)間,放化療就成為其重要治療手段。當(dāng)前,順鉑與氟尿嘧啶聯(lián)合應(yīng)用被認(rèn)為是食管癌的標(biāo)準(zhǔn)及常用治療方案,但其療效提高并不理想,毒副反應(yīng)也較重。近些年來(lái),紫杉醇逐漸應(yīng)用在晚期食管癌的治療上,它被認(rèn)為是食管癌治療方面的有效的藥物之一。沙利度胺是一種非巴比妥類(lèi)鎮(zhèn)靜劑,最先應(yīng)用在早孕反應(yīng)的治療中,后來(lái)由于其可顯著導(dǎo)致胎兒畸形而被禁止應(yīng)用。近些年來(lái)多項(xiàng)研究提示,沙利度胺具有抗腫瘤的作用,其作用機(jī)制主要是抗腫瘤血管生成、誘導(dǎo)細(xì)胞凋亡、免疫調(diào)節(jié)等。當(dāng)前,沙利度胺已經(jīng)應(yīng)用在晚期食管癌、肝癌、小細(xì)胞肺癌、非小細(xì)胞肺癌、膠質(zhì)瘤和惡性黑色素瘤等的輔助治療中,是一種具有潛力且有前景的抗腫瘤藥物。本研究主要是針對(duì)我院(鄭州大學(xué)第一附屬醫(yī)院)腫瘤科2014年4月份至2015年4月份診斷明確的70例晚期食管鱗癌患者的治療效果進(jìn)行研究分析,分別接受沙利度聯(lián)合化療或單純化療,研究的主要觀察指標(biāo)為近期療效、生存率、中位生存時(shí)間、生活質(zhì)量改善及對(duì)藥物不良反應(yīng)的耐受性,從而在食管癌治療方式的選擇方面提供一定的理論依據(jù)。方法該研究的對(duì)象為2014年4月到2015年4月我院腫瘤科收治且經(jīng)病理學(xué)或細(xì)胞學(xué)證實(shí)的70例晚期食管鱗癌患者;TNM分期全部為Ⅳ期;診斷明確后的初次抗腫瘤治療;KPS評(píng)分≥70分;能進(jìn)半流質(zhì)或順利進(jìn)流質(zhì)飲食,未見(jiàn)嚴(yán)重惡病質(zhì)及心血管系統(tǒng)疾病,且無(wú)氣管侵犯現(xiàn)象和穿孔X線征象;多于一個(gè)能夠應(yīng)用影像學(xué)的方法評(píng)估治療效果的病變;預(yù)計(jì)生存時(shí)間3個(gè)月。70例患者按1:1比例隨機(jī)分為2組:對(duì)照組采用紫杉醇聯(lián)合順鉑方案化療,試驗(yàn)組患者在對(duì)照組基礎(chǔ)上同步聯(lián)合使用沙利度胺治療。治療前詳細(xì)告知其可能發(fā)生的不良反應(yīng)和化療過(guò)程中的相關(guān)注意事項(xiàng),若發(fā)生無(wú)法耐受的藥物相關(guān)性不良反應(yīng)時(shí)及時(shí)終止化療。結(jié)果試驗(yàn)組及對(duì)照組患者在完成2周期化療后,可進(jìn)行近期療效評(píng)估的患者共70例,其中試驗(yàn)組:完全緩解(CR)1例,部分緩解(PR)14例,穩(wěn)定(SD)15例,進(jìn)展(PD)5例,疾病控制率(DCR)為85.7%(30/35);對(duì)照組:完全緩解(CR)0例,部分緩解(PR)13例,穩(wěn)定(SD)16例,進(jìn)展(PD)6例,疾病控制率(DCR)為82.9%(29/35);比較試驗(yàn)組與對(duì)照組患者的疾病控制率,組間差異不具有顯著性(P0.05)。在生活質(zhì)量改善方面,與對(duì)照組比較,試驗(yàn)組患者KPS評(píng)分、睡眠和體重變化改善情況均具有明顯優(yōu)勢(shì),組間具有顯著性差異(P0.05)。兩組患者不良反應(yīng)主要表現(xiàn)為血液學(xué)毒性(白細(xì)胞減少、血小板減少、血紅蛋白減少)、胃腸道毒性(惡心、嘔吐)等,以Ⅰ~Ⅱ度不良反應(yīng)為主。試驗(yàn)組病人惡心和嘔吐等消化道反應(yīng)的發(fā)生率明顯低于對(duì)照組,組間差異有統(tǒng)計(jì)學(xué)意義(χ2=5.757,P=0.0160.05);試驗(yàn)組便秘的發(fā)生率高于對(duì)照組(χ2=7.124,P=0.0080.05);其它的不良反應(yīng),兩組間發(fā)生率比較無(wú)明顯差異(P0.05)。治療過(guò)程中試驗(yàn)組與對(duì)照組患者發(fā)生的毒副反應(yīng)經(jīng)臨床對(duì)癥處理后均可控制,并未發(fā)生藥物相關(guān)毒副反應(yīng)導(dǎo)致治療停止的情況,也無(wú)治療相關(guān)的死亡。截止到隨訪日期,試驗(yàn)組和對(duì)照組的中位生存時(shí)間分別為11.0個(gè)月(95%置信區(qū)間為9.267-12.733)和10.0個(gè)月(95%置信區(qū)間為8.344-11.656),兩組生存曲線比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。試驗(yàn)組和對(duì)照組的1年生存率分別為40.0%、31.4%,兩組比較差異均不具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論1.沙利度胺聯(lián)合化療治療晚期食管鱗癌可明顯改善患者的生活質(zhì)量,提高對(duì)化療的順應(yīng)性。2.沙利度胺聯(lián)合化療治療晚期食管鱗癌可明顯降低惡心、嘔吐等消化道反應(yīng)的發(fā)生率,不良反應(yīng)可耐受,沙利度胺用于治療食管癌值得進(jìn)一步研究及推廣。
[Abstract]:Background and objective esophageal cancer is one of the most common malignant digestive system tumors in China. It is easy to encroaches on other tissues and organs. It has strong invasiveness, high degree of malignancy and poor prognosis. The incidence of esophageal cancer is rising in recent years. It has gradually become one of the major malignant diseases that seriously threaten human health and life. Among the malignant tumors, the incidence of esophageal cancer ranks in the sixth place, with a mortality rate of fourth. The incidence of esophageal cancer has obvious regional characteristics. China is one of the high incidence areas of esophageal cancer. Both the incidence and mortality rate in third of the malignant digestive system tumors in China, second only to gastric cancer and liver cancer. Squamous cell carcinoma and squamous cell carcinoma. Adenocarcinoma is the main and representative two major histological type of esophageal cancer. Squamous cell carcinoma occupies most of the cancer of the esophagus in our country. The main risk factors are tobacco and alcohol. The main treatment methods of esophageal cancer are surgery, chemotherapy and radiotherapy. Surgical excision, and in the case of patient tolerable, operation is the primary treatment. Because of its initial metastasis and diffusion, most patients have been in a late period of definite diagnosis and missed the most suitable time for surgical treatment. Chemotherapy and chemotherapy is an important treatment. Current, cisplatin and fluorouracil are considered to be the esophagus. In recent years, paclitaxel has been used in the treatment of advanced esophageal cancer, which is considered to be one of the effective drugs in the treatment of esophageal cancer. Thalidomide is a non barbiturate sedative, first used in the treatment of early pregnancy. In recent years, a number of studies have suggested that thalidomide has an antitumor effect. Its mechanism is mainly anti-tumor angiogenesis, apoptosis and immunomodulation. At present, thalidomide has been used in advanced esophageal, hepatocellular carcinoma, small cell lung cancer, and non small cell lung. In the adjuvant therapy of cancer, glioma and malignant melanoma, it is a potential and promising antitumor drug. This study is mainly aimed at the analysis of the therapeutic effects of 70 patients with advanced esophageal squamous carcinoma diagnosed from April 2014 to April 2015 of our hospital (the First Affiliated Hospital of Zhengzhou University). The main objective of the study was the short-term efficacy, survival, median survival time, quality of life, and tolerance to adverse drug reactions, which provided a theoretical basis for the selection of esophageal cancer treatment. The object of this study was from April 2014 to April 2015 in our hospital. 70 cases of advanced esophageal squamous cell carcinoma confirmed by pathology or cytology were admitted to the Department of oncology. The TNM staging was all IV stage; the first antitumor treatment after diagnosis; the KPS score was more than 70; it could enter a half fluid or a smooth intake of fluid, no severe cachexia and cardiovascular system diseases, and no tracheal invasion and perforation X ray signs; An imaging method was used to evaluate the effect of treatment. The estimated survival time was 3 months for.70 patients randomly divided into 2 groups according to the proportion of 1:1. The control group was treated with paclitaxel combined with cisplatin regimen, and the experimental group was synchronously combined with thalidomide on the basis of the control group. In the process of good reaction and chemotherapy, the chemotherapy was terminated in time for the adverse drug related adverse reactions. Results in the experimental group and the control group, 70 patients were evaluated after 2 cycles of chemotherapy, including 1 cases of complete remission (CR), 14 cases of partial remission (PR), and stability (SD) 15. For example, 5 cases (PD), disease control rate (DCR) was 85.7% (30/35); control group: complete remission (CR) 0 cases, partial remission (PR) 13 cases, stability (SD) 16 cases, progression (PD) 6 cases, disease control rate (DCR) 82.9% (29/35); comparison between the test group and the control group, the difference between the group was not significant (P0.05). In quality of life improvement, and right Compared with group KPS, the patients in the experimental group had obvious advantages in the improvement of sleep and body weight, and there was a significant difference between the groups (P0.05). The two groups of patients were mainly characterized by hematological toxicity (leukocyte reduction, thrombocytopenia, hemoglobin), gastrointestinal toxicity (nausea, vomiting) and so on. The incidence of nausea and vomiting in the experimental group was significantly lower than that of the control group. The difference between the groups was statistically significant (x 2=5.757, P=0.0160.05); the incidence of constipation in the experimental group was higher than that of the control group (x 2=7.124, P=0.0080.05); the other adverse reactions, the incidence of the two groups were not significantly different (P0.05). The side effects of the patients in the control group were controlled after clinical symptomatic treatment. There was no drug related side effects and no treatment related deaths. The median survival time of the test group and the control group was 11 months (95% confidence interval 9.267-12.733) and 10 months (95 months, respectively). % confidence interval was 8.344-11.656). There was no significant difference between the two groups of survival curves (P0.05). The 1 year survival rates of the experimental group and the control group were 40% and 31.4% respectively. The difference of the two groups was not statistically significant (P0.05). Conclusion 1. thalidomide combined with chemotherapy in the treatment of late esophageal squamous cell carcinoma could significantly improve the quality of life of the patients and improve the quality of the patients. .2. thalidomide combined with chemotherapy in the treatment of advanced esophageal squamous cell carcinoma can significantly reduce the incidence of nausea, vomiting and other digestive tract reactions, and the adverse reactions can be tolerated. Thalidomide is worth further research and promotion in the treatment of esophageal cancer.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R735.1

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 趙修南;沙利度胺治療多種癌癥[J];國(guó)外醫(yī)學(xué).藥學(xué)分冊(cè);2001年06期

2 徐榮香,楊建民,王健民;沙利度胺治療難治性多發(fā)性骨髓瘤臨床觀察[J];臨床血液學(xué)雜志;2003年01期

3 吳根容;沙利度胺治療復(fù)發(fā)性/難治性多發(fā)性骨髓瘤的多中心Ⅱ期試驗(yàn):年齡是一負(fù)性預(yù)后因素[J];國(guó)外醫(yī)學(xué)(內(nèi)科學(xué)分冊(cè));2004年02期

4 王華光 ,龍江;沙利度胺的研究現(xiàn)狀及應(yīng)用進(jìn)展[J];首都醫(yī)藥;2004年16期

5 胡喜梅,徐洪,周水陽(yáng),倪君,張紅,何桂鈞,朱碧輝;沙利度胺治療原發(fā)性巨球蛋白血癥療效觀察[J];白血病.淋巴瘤;2004年05期

6 Brocard A.;Barbarot S.;Milpied B.;Stalder J.-F. ;周少娜;;沙利度胺治療慢性盤(pán)狀紅斑狼瘡[J];世界核心醫(yī)學(xué)期刊文摘(皮膚病學(xué)分冊(cè));2006年03期

7 姜鏵;章正華;夏云金;張霞;胡明均;龍志國(guó);萬(wàn)楚成;;聯(lián)合應(yīng)用沙利度胺治療骨髓增生異常綜合征[J];臨床內(nèi)科雜志;2006年05期

8 馬春玉;;沙利度胺的臨床應(yīng)用[J];現(xiàn)代醫(yī)藥衛(wèi)生;2006年17期

9 曾寧;唐莉;袁勁;吳柯;周潔;胡濤;陳忠華;;沙利度胺對(duì)小鼠皮膚移植的影響[J];醫(yī)藥導(dǎo)報(bào);2006年08期

10 林燕;;沙利度胺的臨床應(yīng)用進(jìn)展[J];海峽藥學(xué);2006年06期

相關(guān)會(huì)議論文 前10條

1 趙曉萌;李艷;;烏苯美司聯(lián)合沙利度胺治療復(fù)發(fā)難治性多發(fā)性骨髓瘤的療效觀察[A];全國(guó)中西醫(yī)結(jié)合血液學(xué)學(xué)術(shù)會(huì)議論文匯編[C];2010年

2 陳芊茜;楊濤;呂揚(yáng);;沙利度胺晶型藥物的表征與晶型穩(wěn)定研究[A];第二屆中國(guó)晶型藥物研發(fā)技術(shù)研討會(huì)會(huì)議論文集[C];2010年

3 王雨娟;李新宇;鄭家潤(rùn);;沙利度胺作用機(jī)制探討[A];中國(guó)制藥工業(yè)藥理學(xué)會(huì)20周年學(xué)術(shù)會(huì)議論文集[C];2002年

4 楊文博;孔佩艷;;沙利度胺的作用機(jī)制研究進(jìn)展[A];中華醫(yī)學(xué)會(huì)第八次全國(guó)血液學(xué)學(xué)術(shù)會(huì)議論文匯編[C];2004年

5 戴再友;;沙利度胺臨床應(yīng)用新進(jìn)展[A];2008年浙江省腎臟病學(xué)術(shù)年會(huì)論文匯編[C];2008年

6 李兵;潘海東;何光照;張怡;劉少波;李碩華;李靜清;畢惠嫦;黃民;;CYP2C19基因多態(tài)性與沙利度胺抗肺癌療效和不良反應(yīng)的關(guān)系研究[A];2013年廣東省藥師周大會(huì)論文集[C];2013年

7 王玲;;口服沙利度胺引起泌乳1例[A];中華醫(yī)學(xué)會(huì)第十二次全國(guó)皮膚性病學(xué)術(shù)會(huì)議論文集[C];2006年

8 劉少君;劉林湘;萬(wàn)鼎銘;王桂菊;劉延芳;謝新生;;沙利度胺治療難治性多發(fā)性骨髓瘤的臨床觀察[A];第一屆全國(guó)難治性淋巴瘤學(xué)術(shù)研討會(huì)暨第二屆全國(guó)多發(fā)性骨髓瘤學(xué)術(shù)研討會(huì)（國(guó)家級(jí)血液系統(tǒng)惡性腫瘤繼續(xù)醫(yī)學(xué)教育學(xué)習(xí)班）繼續(xù)教育集[C];2007年

9 李玉富;張艷莉;徐本玲;杜建偉;張麗娜;岳寒;左文麗;朱興虎;呂璐璐;房伯俊;呂曉東;魏旭東;宋永平;;沙利度胺在血液腫瘤的機(jī)制和臨床應(yīng)用[A];第十次全國(guó)淋巴瘤學(xué)術(shù)會(huì)議論文匯編[C];2007年

10 李碧玲;;沙利度胺聯(lián)合化療治療難治性多發(fā)性骨髓瘤19例[A];第一屆全國(guó)難治性淋巴瘤學(xué)術(shù)研討會(huì)暨第二屆全國(guó)多發(fā)性骨髓瘤學(xué)術(shù)研討會(huì)（國(guó)家級(jí)血液系統(tǒng)惡性腫瘤繼續(xù)醫(yī)學(xué)教育學(xué)習(xí)班）繼續(xù)教育集[C];2007年

相關(guān)重要報(bào)紙文章 前7條

1 李勇　譯;研究證實(shí)沙利度胺可用于治療出血性血管疾病[N];中國(guó)醫(yī)藥報(bào);2010年

2 編譯 許關(guān)煜 李敏華;沙利度胺的重生和來(lái)世[N];醫(yī)藥經(jīng)濟(jì)報(bào);2013年

3 山東大學(xué)齊魯醫(yī)院血液科 馬驥 彭軍 侯明;免疫性血小板減少癥 沙利度胺可以用[N];健康報(bào);2013年

4 Annika Breidthardt　編譯 王迪;受害方：道歉太少太遲[N];醫(yī)藥經(jīng)濟(jì)報(bào);2012年

5 雷諾島;沙利度胺“縮水”,硼替佐米“躍升”[N];醫(yī)藥經(jīng)濟(jì)報(bào);2011年

6 陶春祥;沙利度胺治療多發(fā)性骨髓瘤[N];中國(guó)醫(yī)藥報(bào);2004年

7 安明榜;老藥掘金[N];醫(yī)藥經(jīng)濟(jì)報(bào);2009年

相關(guān)博士學(xué)位論文 前10條

1 韓青;SpA髖關(guān)節(jié)炎的診治及相關(guān)動(dòng)物模型的建立[D];第四軍醫(yī)大學(xué);2014年

2 王堅(jiān);沙利度胺治療食管癌的基礎(chǔ)和臨床研究[D];蘇州大學(xué);2016年

3 李勇華;沙利度胺治療多發(fā)性骨髓瘤的臨床與實(shí)驗(yàn)研究[D];第二軍醫(yī)大學(xué);2008年

4 李鈞;沙利度胺、5-氟脲嘧啶對(duì)胃癌細(xì)胞的作用及其機(jī)制的研究[D];山東大學(xué);2008年

5 高斌斌;沙利度胺抑制兔實(shí)驗(yàn)性腹主動(dòng)脈瘤生長(zhǎng)的研究[D];山東大學(xué);2012年

6 徐浩;沙利度胺對(duì)慢性神經(jīng)病理性痛和炎性痛的防治作用及其相關(guān)機(jī)制的研究[D];第四軍醫(yī)大學(xué);2014年

7 崔子連;新型癌基因Cul4A在沙利度胺治療前列腺癌中的作用及機(jī)制研究[D];第二軍醫(yī)大學(xué);2011年

8 蘇飛;沙利度胺對(duì)角質(zhì)形成細(xì)胞分泌VEGF及TNF-α影響的研究[D];北京協(xié)和醫(yī)學(xué)院;2012年

9 劉愛(ài)京;沙利度胺對(duì)膠原誘導(dǎo)性關(guān)節(jié)炎大鼠VEGF、TNF-α表達(dá)及紅細(xì)胞生成的影響[D];河北醫(yī)科大學(xué);2007年

10 王雨娟;沙利度胺等非經(jīng)典抗炎藥物作用機(jī)制研究[D];中國(guó)協(xié)和醫(yī)科大學(xué);2003年

相關(guān)碩士學(xué)位論文 前10條

1 錢(qián)洪;沙利度胺抗腫瘤作用及部分機(jī)制研究[D];安徽醫(yī)科大學(xué);2008年

2 周凝溪;Cereblon在慢性骨髓增殖性腫瘤中表達(dá)的臨床意義[D];河北醫(yī)科大學(xué);2015年

3 張麗華;沙利度胺對(duì)組胺誘導(dǎo)后的人真皮成纖維細(xì)胞增殖活性及Ⅰ、Ⅲ型膠原蛋白、端粒酶mRNA的影響[D];河北醫(yī)科大學(xué);2015年

4 劉瀟衍;恩度和沙利度胺聯(lián)合化療治療轉(zhuǎn)移性結(jié)直腸癌的臨床觀察[D];北京協(xié)和醫(yī)學(xué)院;2015年

5 柳耀賓;沙利度胺及其結(jié)構(gòu)類(lèi)似物調(diào)控CRBN及cullin 4 RING-CRBN E3 泛素連接酶的機(jī)制研究[D];蘇州大學(xué);2015年

6 田維亮;沙利度胺對(duì)克羅恩病合并腸瘺患者腸粘膜血管形成、粘膜組織TNF-α表達(dá)及粘膜愈合的影響[D];南京大學(xué);2013年

7 梁萬(wàn)霞;DOF方案與聯(lián)合沙利度胺對(duì)比一線治療晚期胃癌的臨床研究[D];安徽醫(yī)科大學(xué);2014年

8 王勝楠;沙利度胺對(duì)炎癥性腸病模型鼠緊密連接蛋白表達(dá)的調(diào)節(jié)[D];復(fù)旦大學(xué);2013年

9 孫媛;沙利度胺聯(lián)合奧沙利鉑、5-氟尿嘧啶對(duì)人肝癌HepG2細(xì)胞的VEGF、Caspase-3基因表達(dá)的研究[D];承德醫(yī)學(xué)院;2015年

10 王琳;沙利度胺對(duì)兒童克羅恩病的療效評(píng)估及其抑制血管生成的機(jī)制研究[D];復(fù)旦大學(xué);2014年

，

本文編號(hào)：1992511