比较替莫唑胺联合阿帕替尼与替莫唑胺联合贝伐珠单抗治疗复发或进展性脑胶质瘤得疗效分析

Comparison of the Efficacy of Temozolomide Combined with Apatinib and Temozolomide Combined with Bevacizumab in the Treatment of Recurrent or Progressive Glioma

摘要: 目的：探讨比较替莫唑胺分别联合阿帕替尼和贝伐珠单抗治疗复发或进展性脑胶质瘤的疗效及安全性。方法：选取2012-01-01到2017-12-31间我院放疗科收治的99例术后复发性脑胶质瘤患者为回顾性研究对象，其中43例采用TMZ + APT方案，56例采用TMZ + BEV方案，在治疗后第8周、第20周和第25周进行疗效评价以及不良反应评估，并随访两组患者的总生存率(OS)。结果：TMZ + APT组患者近期及远期疗效(OS)均优于TMZ + BEV (P < 0.05)，两组患者最主要的不良反应是骨髓抑制，TMZ + APT组患者骨髓移植主要发生在3级以上，而TMZ+BEV组患者主要发生在1~2级，两组之间比较差异具有统计学意义(P < 0.05)；高血压主要发生在TMZ + APT组，TMZ + BEV组相对较少，差异具有统计学意义(P < 0.05)；出血以及血栓主要发生在TMZ + BEV组，而TMZ + APT组相对较少，差异无统计学意义。结论：不论近期疗效还是远期疗效，阿帕替尼联合替莫唑胺治疗复发性脑胶质瘤均优于替莫唑胺联合贝伐珠单抗方案，且不良反应级别较低，具有可控性。

Abstract: Objective: To compare the efficacy and safety of temozolomide combined with apatinib and te-mozolomide combined with bevacizumab in the treatment of recurrent or progressive glioma. Methods: A total of 99 patients with recurrent glioma in our hospital were retrospectively selected. Among them, 43 patients underwent TMZ + APT and 56 patients underwent TMZ + BEV. Efficacy and adverse effects were assessed at 8 weeks, 20 weeks, and 25 weeks after treatment, and the overall survival (OS) of the two groups was followed. Results: The short-term outcomes and overall survival (OS) of the TMZ + APT group were better than the TMZ + BEV group (P < 0.05). The most significant adverse reaction was myelosuppression in the two groups. The bone marrow transplantation in the TMZ + APT group occurred mainly above grade 3; the patients in the TMZ + BEV group mainly occurred in grade 1~2. The difference between the two groups was statistically significant (P < 0.05). The hypertension mainly occurred in the TMZ + APT group, and the TMZ + BEV group was relatively less. The difference was statistically significant (P < 0.05); bleeding and thrombosis occurred mainly in the TMZ + BEV group, while the TMZ + APT group was relatively less, but the difference was not statistically significant. Conclusion: Regardless of short-term efficacy or long-term efficacy, temozolomide combined with apatinib is superior to temozolomide combined with bevacizumab in the treatment of recurrent or progressive glioma, and the level of adverse reactions is low and controllable.