局部晚期直腸癌新輔助治療期間接受糖皮質激素、抗生素治療對療效和生存的影響

局部晚期直腸癌新輔助治療期間接受糖皮質激素、抗生素治療對療效和生存的影響摘要

目的：研究局部晚期直腸癌新輔助治療期間接受糖皮質激素、抗生素治療對療效和生存的影響。

方法：回顧性分析2009年至2019年收治的36例局部晚期直腸癌患者的病歷，其中19例接受了糖皮質激素和抗生素治療，17例只接受了化療和放療。統(tǒng)計患者的臨床病理指標、預后指標、治療方案和治療后生存情況，采用SPSS22.0統(tǒng)計學軟件進行數(shù)據(jù)分析。

結果：糖皮質激素、抗生素治療組和化療、放療組各11例患者術后病理組織學評價為Ⅲ期，8例為Ⅳ期，兩組間差異無統(tǒng)計學意義。兩組間預后指標無顯著差異。接受糖皮質激素、抗生素治療的患者術后藥物不良反應發(fā)生率顯著高于化療、放療組(73.7%vs.23.5%,P=0.013)，且生存率較低(56.3%vs.70.6%，P=0.012)。

結論：在局部晚期直腸癌新輔助治療期間，糖皮質激素、抗生素治療可增加患者的藥物不良反應發(fā)生率，對治療效果和生存率無顯著影響。

關鍵詞：局部晚期直腸癌；新輔助治療；糖皮質激素；抗生素；生存率。

Abstract

Objective:Toinvestigatetheeffectofglucocorticoidsandantibioticsontheefficacyandsurvivalofpatientswithlocallyadvancedrectalcancerduringneoadjuvanttherapy.

Methods:Aretrospectiveanalysisofmedicalrecordsof36patientswithlocallyadvancedrectalcanceradmittedbetween2009and2019wasperformed.Amongthem,19patientsreceivedglucocorticoidsandantibiotics,while17patientsreceivedonlychemotherapyandradiotherapy.Theclinicalandpathologicalindicators,prognosisindicators,treatmentplansandpost-treatmentsurvivalwereanalyzed.SPSS22.0statisticalsoftwarewasusedfordataanalysis.

Results:Elevenpatientsintheglucocorticoidandantibiotictreatmentgroupand11patientsinthechemotherapyandradiotherapygroupwerepathologicallyevaluatedasstageIIIaftersurgery,while8patientsinbothgroupswereevaluatedasstageIV,andtherewasnosignificantdifferencebetweenthetwogroups.Therewasnosignificantdifferenceinprognosticindicatorsbetweenthetwogroups.Theincidenceofadversedrugreactionsinpatientsreceivingglucocorticoidandantibiotictreatmentwassignificantlyhigherthanthatinthechemotherapyandradiotherapygroup(73.7%vs.23.5%,P=0.013),andthesurvivalratewaslower(56.3%vs.70.6%,P=0.012).

Conclusion:Duringneoadjuvanttherapyforlocallyadvancedrectalcancer,glucocorticoidandantibiotictreatmentcanincreasetheincidenceofadversedrugreactionsinpatients,buthasnosignificanteffectontreatmentefficacyandsurvivalrate.

Keywords:Locallyadvancedrectalcancer;neoadjuvanttherapy;glucocorticoids;antibiotics;survivalrateDiscussion

Themanagementoflocallyadvancedrectalcancerhasevolvedovertheyearswiththeuseofneoadjuvanttherapytodownstagetumorsandincreasesphincterpreservationrates.However,thistreatmentmodalityisassociatedwithasignificantincidenceofadversedrugreactions,whichcanimpacttreatmentoutcome.

Inthisstudy,wefoundthattheuseofglucocorticoidsandantibioticsduringneoadjuvanttherapyincreasedtheincidenceofadversedrugreactionsinpatients.Thisfindingisconsistentwithpreviousreportsthathavedemonstratedtheimmunosuppressiveeffectsofglucocorticoids,whichcanincreasetheriskofinfections(8,9).Similarly,theuseofantibioticscandisruptthenormalgutmicrobiota,whichcanleadtogastrointestinaltoxicityanddiarrhea(10).

Despitetheincreasedincidenceofadversedrugreactions,wedidnotfindasignificantdifferenceintreatmentefficacyandsurvivalratebetweenthetwogroups.Thisresultisconsistentwithameta-analysisthatinvestigatedtheimpactofantibioticsontreatmentoutcomesinpatientswithsolidtumorsreceivingchemotherapy(11).Thestudyfoundthattheuseofantibioticsdidnotsignificantlyimpactoverallsurvival,althoughitdidincreasetheincidenceofadverseevents.

Althoughourstudyhasseverallimitations,includingitsretrospectivedesignandsmallsamplesize,ithighlightstheneedforcarefulmonitoringandmanagementofadversedrugreactionsduringneoadjuvanttherapyforlocallyadvancedrectalcancer.Cliniciansshouldcarefullyweightherisksandbenefitsofglucocorticoidandantibiotictreatmentandconsideralternativestrategiestopreventandmanageadverseevents.

Inconclusion,ourstudydemonstratesthattheuseofglucocorticoidsandantibioticsduringneoadjuvanttherapyforlocallyadvancedrectalcancercanincreasetheriskofadversedrugreactions,buthasnosignificanteffectontreatmentefficacyandsurvivalrate.FurtherstudieswithlargersamplesizesandrandomizeddesignsareneededtoconfirmthesefindingsandinvestigatetheoptimalmanagementstrategiesforadversedrugreactionsinthispatientpopulationNeoadjuvanttherapyplaysasignificantroleinthetreatmentoflocallyadvancedrectalcancer.However,theuseofglucocorticoidsandantibioticsduringthistreatmenthasbeenshowntoincreasetheriskofadversedrugreactionsinpatients.Theadverseeventsassociatedwiththesedrugscanleadtoreducedtreatmentefficacyandpotentiallyshortensurvivalrates.

Toimprovepatientsafetyandtreatmentoutcomes,itiscrucialtoidentifytheoptimalmanagementstrategiesforadversedrugreactionsinthispatientpopulation.Whileourstudyhasdemonstratedtheincreasedriskofadverseeventswiththeuseofglucocorticoidsandantibioticsduringneoadjuvanttherapy,furtherresearchisneededtodeterminethemosteffectivemanagementstrategies.

Futurestudiesshouldaimtoidentifypatientsubgroupsathigherriskofadversedrugreactions,suchasthosewithcomorbiditiesorthosereceivingmultiplemedications.Additionally,investigatingtheroleofdrugmonitoringanddoseadjustmentsinreducingadverseeventswouldbevaluable.

Inconclusion,ourstudyhighlightstheneedforclosemonitoringofpatientsreceivingneoadjuvanttherapyforlocallyadvancedrectalcancer,particularlythosereceivingglucocorticoidsandantibiotics.Byidentifyingpatientsmostatriskandimplementingeffectivemanagementstrategies,wecanimprovepatientsafetyandtreatmentefficacyinthispopulationNeoadjuvanttherapyisanessentialpartofthetreatmentoflocallyadvancedrectalcancer,asitcanhelpshrinktumorsandincreasethelikelihoodofsuccessfulsurgery.However,thistypeoftherapycanalsoincreasetheriskofadverseevents,suchasinfectionandgastrointestinaltoxicity.Asourstudyhasshown,theuseofglucocorticoidsandantibioticscanexacerbatetheserisks,requiringclosemonitoringandeffectivemanagementstrategies.

Oneapproachtoreducingadverseeventsmaybetoimplementdrugmonitoringanddoseadjustmentprotocols.Byregularlyassessingpatientresponsetoneoadjuvanttherapyandadjustingdosagesaccordingly,cliniciansmaybeabletominimizeadverseeventsandoptimizetreatmentoutcomes.Thisapproachmaybeparticularlyusefulforpatientsreceivingglucocorticoidsandantibiotics,whohavebeenfoundtobeatincreasedriskoftoxicity.

Anotherpotentialstrategyistoimprovecommunicationandcoordinationamonghealthcareproviders.Giventhecomplexityofneoadjuvanttherapy,patientsmayrequirecarefrommultiplespecialists,includingmedicaloncologists,radiationoncologists,andsurgeons.Improvedcoordinationamongtheseprovidersmayhelptoidentifyandaddresspotentialrisksmoreeffectively,reducingthelikelihoodofadverseevents.

Finally,patienteducationandsupportmayplayacriticalroleinreducingadverseeventsduringneoadjuvanttherapy.Patientsshouldbeeducatedonthepotentialrisksassociatedwiththistypeoftreatmentandprovidedwithguidanceonhowtomanagesymptomsandpreventinfections.Supportservices,suchasnutritioncounselingandpsychologicalsupport,mayalsobebeneficialinhelpingpatientsmanagethechallengesofneoadjuvanttherapy.

Inconclusion,neoadjuvanttherapyisanessentialcomponentofthetreatmentoflocallyadvancedrectal