目的: 评价卡培他滨（capecitabine）联合依立替康（irinotecan）或重组人血管内皮抑制素( rhendostatin，商品名为恩度)治疗奥沙利铂（oxaliplatin）耐药晚期结直肠癌的疗效及安全性。方法: 回顾性分析45例奥沙利铂治疗无效的晚期结直肠癌患者的临床资料,采用卡培他滨联合依立替康治疗25例、卡培他滨联合恩度治疗20例。结果:随访3～21个月, 依立替康组有效率（RR）为32.0%, 临床受益率（CBR）为72.0％，肿瘤进展时间（TTP）为6.2（95％可信区间： 3.125～8.905）个月； 恩度组RR为55.0%, CBR为90.0%， TTP为10.6(95％可信区间： 7.876～12.962）个月;两组比较各项指标差异均有统计学意义( P<0.05) 。两组总生存期（OS）分别为15.2（95％可信区间： 12.576～17.842）个月和16.1（95％可信区间： 13988～18234）个月，差异无统计学意义。依立替康组生活质量（QOL）改善者有2例(8.0%), 稳定者6例(24.0%), 下降17例(68.0%)；恩度组改善者有12例(60.0%), 稳定者6例(30.0%), 下降2例(10.0%)，差异有统计学意义( P<001)。治疗的不良反应，依立替康组中性粒细胞减少、腹泻发生率明显高于恩度组( P<0.01)。结论: 对奥沙利铂治疗无效或失败的晚期结直肠癌患者，卡培他滨联合依立替康或恩度是可供选择的方案，后者方案具有更好的疗效和安全性

Objective: To evaluate the efficacy and safety of capecitabine combined with irinotecan or rhendostatin（endostar）for the treatment of oxaliplatinresistant patients with advanced colorectal cancer. Methods: Fortyfive patients with oxaliplatinresistant advanced colorectal cancer were included in this study. Twentyfive of them were treated with capecitabine combined with irinotecan and 20 of them were treated with capecitabine combined with endostar. Results:The followup period was 321 months. The response rate(RR) was 32.0% in irinotecan treated patients; the clinical benefit rate (CBR) was 72.0%; time of tumor progression (TTP) was 6.2 (95％CI: 3.125~8.905) months. The RR was 55.0% in endostar treated patients; the CBR was 90.0% and TTP was 10.6 (95％CI: 7.876~12.962) months. There was significant difference between the two groups concerning the above three parameters (P<0.05). The overall survival periods (OS) of the two groups were 15.2 (95％CI: 12.576~17.842) and 16.1 (95％CI:13.988~18.234) months, respectively, with no significant difference (P>0.05). The quality of life (QOL) was improved in 2 cases (80%), kept stable in 6 cases (24.0%), and decreased in 17 cases (68.0%) in irinotecan treated group; the numbers in the endostar treated group were 12 (60.0%), 6 (30.0%), and 2 (10.0%), respectively, with significant difference between the two groups(P<0.01). The incidences of drugrelated adverse events, neutropenia and diarrhea, were higher in the irinotecan group than in the endostar group (P<0.01). Conclusion: Capecitabine combined with irinotecan or endostar are alternative therapies for oxaliplatinresistant patients with advanced colorectal cancer, and capecitabine combined with endostar is more effective and safe.

广东省医学科研资助项目(No.A2008450)