国际肿瘤学杂志

国际肿瘤学杂志 ›› 2024, Vol. 51 ›› Issue (11): 690-695.doi: 10.3760/cma.j.cn371439-20240618-00117

• 论著 • 上一篇    下一篇

伊立替康联合XELOX方案对老年结直肠癌患者机体免疫状态、肠道微生态的影响及预后风险分析

陈坤燕1, 杜娟2, 季雨伟2, 顾卫卫2, 彭涵智2()   

  1. 1江苏省启东市人民医院/启东肝癌防治研究所/南通大学附属启东医院肿瘤内科，启东 226200
    2江苏省启东市人民医院/启东肝癌防治研究所/南通大学附属启东医院药剂科，启东 226200
  • 收稿日期:2024-06-18 修回日期:2024-09-16 出版日期:2024-11-08 发布日期:2024-12-26
  • 通讯作者: 彭涵智 E-mail:630210907@qq.com
  • 基金资助:
    南通市卫生健康委员会科研课题(QNZ2022086)

Effects of irinotecan combined with XELOX regimen on immune status， intestinal microecology and prognostic risk in elderly patients with colorectal cancer

Chen Kunyan1, Du Juan2, Ji Yuwei2, Gu Weiwei2, Peng Hanzhi2()   

  1. 1Department of Medical Oncology， Qidong People's Hospital of Jiangsu Province， Qidong Liver Cancer Institure， Affiliated Qidong Hospital of Nantong University， Qidong 226200， China
    2Department of Pharmacy， Qidong People's Hospital of Jiangsu Province， Qidong Liver Cancer Institure， Affiliated Qidong Hospital of Nantong University， Qidong 226200， China
  • Received:2024-06-18 Revised:2024-09-16 Online:2024-11-08 Published:2024-12-26
  • Contact: Peng Hanzhi E-mail:630210907@qq.com
  • Supported by:
    Nantong Municipal Health Commission Research Project(QNZ2022086)

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摘要：

目的 分析伊立替康联合XELOX方案对老年结直肠癌患者机体免疫状态、肠道微生态的影响及预后风险。方法 选择2018年10月—2023年4月江苏省启东市人民医院收治的105例老年晚期结直肠癌患者为研究对象。按照化疗方案不同分为对照组（n=45）、观察组（n=60）。对照组采用单独XELOX化疗方案，观察组采用伊立替康联合XELOX化疗方案，比较两组近期疗效，治疗前、后免疫状态、肠道微生态相关指标变化。治疗结束后以随访期间死亡或复发转移为终点事件，将105例患者分为预后不良组（n=32）、预后良好组（n=73），并比较两组临床资料，多因素logistic回归分析影响老年晚期结直肠癌患者预后的因素。结果 观察组近期总有效率为53.33%（32/60），高于对照组的20.00%（9/45）（χ2=12.01，P=0.001）。治疗结束后1周，观察组CD4+ T细胞占比、CD4+/CD8+比值分别为（38.59±1.50）%、1.81±0.20，均高于对照组的（36.25±1.82）%、1.59±0.15（t=7.22，P<0.001；t=6.19，P<0.001）；CD8+ T细胞占比为（21.27±2.70）%，低于对照组的（22.80±2.92）%（t=2.78，P=0.007）；双歧杆菌、嗜酸乳杆菌、粪肠球菌数量分别为（9.44±0.82）、（9.89±0.79）、（9.14±0.66）lg CFU/g，均多于对照组的（8.20±0.70）、（9.05±0.72）、（8.25±0.62）lg CFU/g（t=8.16，P<0.001；t=5.60，P<0.001；t=7.02，P<0.001）。预后良好组、预后不良组吸烟饮酒史比例（χ2=7.61，P=0.006）、低分化比例（χ2=6.54，P=0.011）、淋巴结转移比例（χ2=5.86，P=0.016）及化疗前癌胚抗原（CEA）水平[（5.80±0.89）μg/L比（7.48±1.02）μg/L，t=8.51，P<0.001]、糖类抗原199（CA199）水平[（29.54±1.85）U/ml比（34.52±2.50）U/ml，t=11.36，P<0.001]比较，差异均具有统计学意义。多因素分析显示，吸烟饮酒史（OR=1.74，95%CI为1.53~2.15，P<0.001）、低分化（OR=1.80，95%CI为1.60~2.15，P<0.001）、淋巴结转移（OR=1.82，95%CI为1.68~2.33，P<0.001）、化疗前CEA水平高（OR=1.81，95%CI为1.62~2.38，P<0.001）、化疗前CA199水平高（OR=1.80，95%CI为1.66~2.37，P<0.001）均是影响老年晚期结直肠癌预后的危险因素。结论 伊立替康联合XELOX方案可有效改善老年晚期结直肠癌患者免疫功能、肠道微生态，但化疗后预后不良风险较高，吸烟饮酒史、低分化、淋巴结转移、化疗前CEA水平高、化疗前CA199水平高均是影响老年晚期结直肠癌患者预后的危险因素。

关键词: 结直肠肿瘤, 伊立替康, 胃肠道微生物组, XELOX方案

Abstract:

Objective To analyze the effects of irinotecan combined with XELOX regimen on immune status， intestinal microecology and prognostic risk in elderly patients with colorectal cancer. Methods A total of 105 elderly patients with advanced colorectal cancer admitted to Qidong People's Hospital of Jiangsu Province from October 2018 to April 2023 were included as the study objects. They were divided into control group （n=45） and observation group （n=60） according to different chemotherapy regimen. The control group was treated with XELOX regimen alone， and the observation group was treated with irinotecan combined with XELOX regimen. The short-term efficacy， changes of indexes related to immune status and intestinal microecology before and after treatment were compared between the two groups. The patients were followed up from the end of treatment. With death or recurrence and metastasis as the end event during the follow-up， 105 patients were divided into poor prognosis group （n=32） and good prognosis group （n=73）. The clinical data of the two groups were compared， and multivariate logistic regression was used to analyze the prognostic factors in elderly patients with advanced colorectal cancer. Results The total effective rate of the observation group was 53.33% （32/60）， which was higher than that of the control group （20.00%， 9/45） （χ2=12.01， P=0.001）. One week after treatment， the ratios of CD4+ T cells and CD4+/CD8+ in the observation group were （38.59±1.50）% and 1.81±0.20， respectively， higher than those in the control group （36.25±1.82）% and 1.59±0.15 （t=7.22， P<0.001； t=6.19， P<0.001）. The ratio of CD8+ T cells was （21.27±2.70）%， lower than that of the control group （22.80±2.92）% （t=2.78， P=0.007）. The numbers of Bifidobacterium， Lactobacillus and Enterococcus were （9.44±0.82）， （9.89±0.79）， （9.14±0.66） lg CFU/g， respectively， which were higher than those in the control group （8.20±0.70）， （9.05±0.72）， （8.25±0.62） lg CFU/g （t=8.16， P<0.001； t=5.60， P<0.001； t=7.02， P<0.001）. There were statistically significant differences in the proportion of smoking and drinking history （χ2=7.61， P=0.006）， the proportion of low differentiation （χ2=6.54， P=0.011）， the proportion of lymph node metastasis （χ2=5.86， P=0.016） and the level of carcinoembryonic antigen （CEA） before chemotherapy [（5.80±0.89） μg/L vs. （7.48±1.02） μg/L， t=8.51， P<0.001]， the level of carbohydrate antigen 199 （CA199） [（29.54±1.85） U/ml vs. （34.52±2.50） U/ml， t=11.36， P<0.001] in good prognosis group and poor prognosis group. Multivariate analysis showed that smoking and drinking history （OR=1.74， 95%CI： 1.53-2.15， P<0.001）， low differentiation （OR=1.80， 95%CI： 1.60-2.15， P<0.001）， lymph node metastasis （OR=1.82， 95%CI： 1.68-2.33， P<0.001）， high CEA level before chemotherapy （OR=1.81， 95%CI： 1.62-2.38， P<0.001）， high CA199 level before chemotherapy （OR=1.80， 95%CI： 1.66-2.37， P<0.001） were risk factors for the prognosis of advanced colorectal cancer in the elderly. Conclusion Irinotecan combined with XELOX regimen can effectively improve immune function and intestinal microecology in elderly patients with advanced colorectal cancer， but the risk of poor prognosis after chemotherapy is higher. Smoking and drinking history， low differentiation， lymph node metastasis， high CEA level before chemotherapy， and high CA199 level before chemotherapy are risk factors affecting the prognosis of elderly patients with advanced colorectal cancer.

Key words: Colorectal neoplasms, Irinotecan, Gastrointestinal microbiome, XELOX regimen