目的 比較西妥昔單抗聯合FOLFOX4與貝伐單抗聯合FOLFOX4兩種方案治療野生型KRAS晚期直腸癌的臨床療效及安全性。方法 選取2012年1月-2017年1月至柳州市柳江區(qū)人民醫(yī)院腫瘤內科治療的野生型KRAS晚期直腸癌患者75例，根據治療方案的不同分為A、B、C 3組，A組23例單純利用FOLFOX4方案治療，B組27例采用貝伐單抗聯合FOLFOX4方案，C組25例采用西妥昔單抗聯合FOLFOX4方案，比較各組臨床有效率，觀察每組不良反應發(fā)生情況。隨訪后，計算各組平均無進展生存期（PFS）。結果 3組客觀有效率（ORR）分別為13.04%、51.85%、60.00%，AB、AC組間比較差異均有統(tǒng)計學意義（P<0.01），B、C兩組間差異無統(tǒng)計學意義。3組疾病控制率（DCR）分別為73.91%、88.89%、92.00%，各組之間兩兩比較差異也均無統(tǒng)計學意義。A、B、C 3組中位PFS分別為8.2、10.1、9.4個月，3組間中位PFS差異無統(tǒng)計學意義，3組患者均未出現治療相關的死亡，主要不良反應有骨髓抑制和嘔吐，另外偶發(fā)外周神經毒性、肝損傷、手足綜合癥等，發(fā)生率較低。B組未出現貝伐單抗相關的高血壓、鼻出血、腸穿孔等不良反應，C組出現6例皮疹（24.00%）。結論 西妥昔單抗或貝伐單抗聯合FOLFOX4方案均可提高野生型KRAS晚直腸癌的臨床療效，兩種方案療效相當，不良反應均較小，值得臨床推廣使用。

Objective To compare the clinical efficacy and safety of cetuximab plus FOLFOX4 and bevacizumab combined with FOLFOX4 in the treatment of wild-type KRAS advanced rectal cancer.Methods From January 2012 to January 2017,75 patients with wild type KRAS advanced rectal cancer treated in our department were divided into A,B and C groups according to the treatment regimen,and 23 patients in group A FOLFOX4 regimen,27 patients in group B received bevacizumab combined with FOLFOX4 regimen,25 patients in group C received cetuximab plus FOLFOX4 regimen.The clinical efficacy of each group was compared,and the incidence of adverse reactions in each group was observed.After follow-up,mean progression-free survival (PFS) was calculated for each group.Results The objective response rates (ORR) of three groups were 13.04%,51.85% and 60.00%,respectively,with significant difference between the three groups (P<0.01).The difference between A and C,B and C groups was statistically significant (P<0.01).There was no significant difference between B and C groups.The control rates (DCR) were 73.91%,88.89%,92.00% respectively.There was no significant difference among the three groups.The median PFS of group A,B and C were 8.2 months,10.1 months and 9.4 months respectively.There was no significant difference in median PFS between the three groups.Related to death,the main adverse reactions are myelosuppression and vomiting,the other occasional peripheral neurotoxicity,liver injury,hand-foot syndrome,the incidence is low.B group did not appear bevacizumab related hypertension,nosebleeds,intestinal perforation and other adverse reactions,C group appeared in 6 cases of rash (24.00%).Conclusion Both cetuximab and bevacizumab combined with FOLFOX4 can improve the clinical efficacy of wild-type KRAS late-rectal cancer.The two regimens have similar curative effect and small adverse reactions,which are worthy of clinical promotion.