2021 年第 10 期 第 16 卷

尼妥珠单抗联合吉西他滨和替吉奥方案用于晚期胰腺癌的疗效观察及对癌组织中E钙黏蛋白和β-连环蛋白表达的影响

Effect of nimotuzumab combined with gemcitabine and tegafur gimeracil oteracil potassium on the treatment of advanced pancreatic cancer and on expressions of E-cadherin and β-catenin in cancer tissue

作者：马艳荣1赵莉2王永增2张静1王立鹏1李唯源1

英文作者：Ma Yanrong1 Zhao Li2 Wang Yongzeng2 Zhang Jing1 Wang Lipeng1 Li Weiyuan1

单位：1河北省唐山中心医院肿瘤科063000；2河北省唐山工人医院消化科063000

英文单位：1Department of Oncology Tangshan Central Hospital Hebei Province Tangshan 063000 China; 2Department of Gastroenterology Tangshan Gongren Hospital Hebei Province Tangshan 063000 China

关键词：胰腺癌；尼妥珠单抗；吉西他滨；替吉奥；E钙黏蛋白；β-连环蛋白

英文关键词：Pancreaticcancer;Nimotuzumab;Gemcitabine;Tegafurgimeraciloteracilpotassium;E-cadherin;β-catenin

• 摘要：

• 目的  探讨尼妥珠单抗联合GS（吉西他滨+替吉奥）方案用于晚期胰腺癌的疗效及对癌组织中E钙黏蛋白、β-连环蛋白表达的影响。方法 选取2017年1月至2019年12月唐山工人医院收治的136例晚期胰腺癌患者，根据药物治疗方式不同分为对照组和观察组，各68例。对照组采用GS方案治疗，观察组采用尼妥珠单+GS方案治疗，21 d为1个周期。治疗2个周期后对2组患者临床疗效及安全性进行评估。比较2组治疗前和治疗2个周期后病灶组织中表皮生长因子受体（EGFR）、人类表皮生长因子受体2（HER2）、细胞增殖核抗原Ki-67（Ki-67）、E钙黏蛋白和β-连环蛋白表达情况及预后随访结果 。结果 治疗2个周期后，观察组客观缓解率、疾病控制率均明显高于对照组［41.2%（28/68）比27.9%（19/68）、82.4%（56/68）比66.2%（45/68）］，差异均有统计学意义（均P＜0.05）。2组治疗后EGFR、HER2、Ki-67和β-连环蛋白表达水平均低于治疗前，且观察组均低于对照组，E钙黏蛋白表达水平高于治疗前，且观察组高于对照组，差异均有统计学意义（均P＜0.05）。2组Ⅰ～Ⅱ级和Ⅲ～Ⅳ级不良反应发生率比较差异均无统计学意义（均P＞0.05）。观察组、对照组中位无进展生存期分别为10.4和7.2个月，组间比较差异有统计学意义（P＜0.05）；观察组1年生存率、1年无进展生存率均明显高于对照组［70.6%（48/68）比42.6%（29/68）、39.7%（27/68）比20.6%（14/68）］（均P＜0.05）。结论 尼妥珠单抗联合GS化疗方案治疗晚期胰腺癌患者的效果优于单纯GS化疗方案治疗，联合治疗提高了病灶组织中E钙黏蛋白表达水平，降低了β-连环蛋白表达水平，抑制肿瘤进展，延长患者生存期，且不会增加不良反应发生率。

• Objective To investigate the effect of nimotuzumab combined with GS regimen(gemcitabine+tegafur gimeracil oteracil potassium) on the treatment of advanced pancreatic cancer and on expressions of E-cadherin and β-catenin. Methods From January 2017 to December 2019, 136 patients with advanced pancreatic cancer admitted to Tangshan Gongren Hospital were selected. They were divided into control group and observation group according to different drug treatment methods, with 68 cases in each group. The control group was treated with GS regimen, and the observation group was treated with nimotuzumab+GS regimen, 21 d as a cycle. After two cycles of treatment, the clinical efficacy and safety of the two groups were evaluated. The expressions of epidermal growth factor receptor (EGFR), human epidermal growth factor receptor 2 (HER2), proliferation cell nuclear antigen Ki-67(Ki-67), E-cadherin and β-catenin in the lesion tissues before and after two cycles of treatment were compared between the two groups. The prognosis and follow-up results of the two groups were compared. Results After two cycles of treatment, objective response rate and disease control rate in observation group were significantly higher than those in control group［41.2%(28/68) vs 27.9%(19/68), 82.4%(56/68) vs 66.2%(45/68)］(both P＜0.05). After treatment, expressions of EGFR, HER2, Ki-67 and β-catenin in both groups were significantly lower than those before treatment, and those in observation group were lower than those in control group; the expression of E-cadherin  in both groups was significantly higher than that before treatment, and that in observation group was higher than that in control group (all P＜0.05). There were no significant differences in the incidences of grade Ⅰ-Ⅱ and grade Ⅲ-Ⅳ adverse reactions between the two groups (both P＞0.05). The median progression-free survival was 10.4 months in observation group and 7.2 months in control group (P＜0.05). The 1-year survival rate and 1-year progression-free survival rate in observation group were significantly higher than those in the control group［70.6%(48/68) vs 42.6%(29/68), 39.7%(27/68) vs 20.6%(14/68)］(both P＜0.05). Conclusions  The clinical efficacy of nimotuzumab combined with GS chemotherapy on the treatment of patients with advanced pancreatic cancer is better than GS chemotherapy alone, which increases the expression of E-cadherin, reduces the expression level of β-catenin, inhibits tumor progression, prolongs the survival time of patients, and does not increase the incidence of adverse reactions.  correlated. Combined detection of serum lncRNA SNHG16 and miR-16-5p levels can improve the diagnostic value in gastric cancer.