目的 對比觀察培美曲塞聯(lián)合吉西他濱化療與吉西他濱單藥治療胰腺癌的臨床療效,進(jìn)一步優(yōu)化胰腺癌化療方案.方法 將72例非手術(shù)治療的胰腺癌患者隨機(jī)分為兩組:聯(lián)合化療組35例,靜脈滴注培美曲塞600 mg/m²與吉西他濱1 000 mg/m²聯(lián)合化療.單藥治療組37例,吉西他濱單藥600 mg/m²化療,療程均為4個(gè)周期(每個(gè)周期間隔21 d).26周進(jìn)行近期療效及安全性分析,隨訪2年觀察患者生存期.結(jié)果 (1)疾病控制率(DCR):聯(lián)合治療組為62.86%,單藥治療組為51.35%,兩組比較差異無統(tǒng)計(jì)學(xué)意義(χ²=0.97,P=0.32);但早期患者聯(lián)合治療組DCR(85.71%)優(yōu)于單藥治療組(56.52%),兩組比較差異有統(tǒng)計(jì)學(xué)意義(χ²=4.49,P=0.034);(2)生存時(shí)間:聯(lián)合治療組中位生存時(shí)間為8.9個(gè)月,單藥治療組為8.1個(gè)月,兩組比較無統(tǒng)計(jì)學(xué)差異.(3)不良反應(yīng):聯(lián)合治療組粒細(xì)胞、血小板減少和肝功能異常的發(fā)生率(60.2%、53.9%、54.2%)均高于單藥組(32.1%、24.3%、27.0%),差異有統(tǒng)計(jì)學(xué)意義(P <0.05).結(jié)論 培美曲塞與吉西他濱聯(lián)合化療可以提高早期胰腺癌患者的療效,同時(shí)也相應(yīng)地增加對骨髓造血功能的抑制和肝損傷的風(fēng)險(xiǎn).

Objective To observe the different effects of Pemetrexed combined with Gemcitabine vs Gemcitabine alone in treatment of pancreatic adenocarcinoma, and to optimize the chemotherapy further. Methods The pancreatic cancer patients (72 cases) with non-surgical treatment were divided into two groups. The 35 patients in combined group were administered with Pemetrexed 600 mg/m²combined with Gemcitabine 1 000 mg/m², and the 37 patients in monotherapy group accepted Gemcitabine single for 4 cycles (Q21days). The shot-term efficacy and safety were observed and analysed at 26 weeks. The survival time of patients was followed up for 2 years. Results (1) The disease control rate (DCR) of two groups had no significant difference (χ²= 0.97, P= 0.32), and that of combined group was 62.86%, monotherapy group was 51.35%. But the DCR of combined group was higher than that of the other group in the early stage patients (85.71% vs 56.52%), with significant difference (χ²= 4.49, P= 0.034). (2) The medium survival time was 8.9 months in combined group and 8.1 months in monotherapy group. There was no difference between two groups. (3) The incidence rate of neutrophilic granulocytopenia, thrombocytopenia, and liver function damage in combined group (60.2%, 53.9%, and 54.2%) were higher than those in the other group (32.1%, 24.3%, and 27.0%). There was significant difference between two groups, but the incidence rate of the whole body and the digestive tract symptoms in two groups had no difference. Conclusion Pemetrexed combined with Gemcitabine chemotherapy could improve the curative effect of early pancreatic carcinoma vs Gemcitabine singe chemotherapy, however, increased the inhibition of bone marrow hematopoietic function and live function damage meanwhile.