| Objectives:To investigate the efficacy and adverse reactions of apatinib in the treatment of advanced metastatic gastric cancer,and to evaluate the value of apatinib in the treatment of advanced gastric cancer.Methods:From December 2016 to June 2018,73 patients with advanced gastric cancer were selected from the department of oncology,the First Affiliated Hospital of Soozhou University,including 48 males and 25 females.The average age was 61.94 years(25～83);Degree of tissue differentiation:45 cases were low differentiated,17 cases were medium differentiated,and 11 cases were highly differentiated adenocarcinoma.The score of the Eastern Cooperative Oncology Group(ECOG)in the United States was≤3 points,and the expected survival period was≥3 months.The clinical stages were all Phase Ⅳ.All patients were treated with apatinib mesylate tablets.The condition data and demographic information of each patient were comprehensively collected from the HIS system of the hospital.On this basis,the therapeutic effect of Apatinib was analyzed.The incidence of adverse reactions during the treatment of all patients was statistically analyzed to determine the most likely grade Ⅲ and Ⅳ adverse reactions during the treatment of apatinib.73 patients were stratified according to different gender,different age stages,different ECOG scores,number of therapeutic lines,drug dosage and degree of tissue differentiation,and the incidence of Ⅲ and Ⅳ degree adverse reactions in different subgroups of patients were compared.Taking Ⅲ and Ⅳ adverse reactions as dependent variables,independent risk factors for the occurrence of Ⅲ and Ⅳ adverse reactions were explored through Logistic multivariate analysis.Results:1.Short-term efficacy:According to the response evaluation criteria for solid tumors(solid tumors,RECIST):complete remission(CR):all target lesions disappeared and maintained for more than 4 weeks.Partial remission(PR):the total length and diameter of baseline lesions decreased by 30%and maintained for more than 4 weeks.Stable disease(SD):the total length and diameter of the baseline target lesions decreased but did not achieve partial remission,or increased but did not reach the degree of progress.Progressive disease(PD):the total length and diameter of the baseline target lesions increased by 20%or new lesions appeared.Objective response rate(ORR)=CR+PR.Disease control rate(DCR)=CR+PR+SD.After treatment,the CR rate was 0.00%(0/73),PR rate was 15.07%(11/73),SD rate was 30.14%(22/73),PD rate was 54.79%(40/73),ORR rate was 15.07%(11/73),DCR rate was 45.21%(33/73).2.Follow-up:Follow-up for 6 months,median PFS was 3.73 months.3.Incidence of adverse events(AE):73 patients all had AE(the following AE was changed to AE),the incidence rate was 100%,43 patients(58.90%)had AE of grade Ⅲ andⅣ,,and the six kinds of AE with the highest incidence rate were hypertension(41,56.16%),hand-foot syndrome(32,43.84%),anorexia(31,42.47%),asthenia(28,38.36%),proteinuria(26,35.62%),hypoalbuminemia(24,32.88%);The highest incidences of Ⅲ and Ⅳ AE were hypertension(24,32.88%),hand-foot syndrome(10,13.70%),diarrhea(9,12.33%),stomatitis(7,9.59%),proteinuria(6,8.22%),nausea and vomiting(5,6.85%).4.Ⅲ,Ⅳ degree adverse reaction risk factors:ECOG score 2-3 points Ⅲ,Ⅳ degree adverse reaction rate is higher than ECOG score 0-1 points,>2 line treatment Ⅲ,Ⅳdegree adverse reaction rate is higher than≤2 In the line therapy,the incidence of grade Ⅲand Ⅳ adverse reactions in patients with poorly differentiated tissues was higher than that in moderately high differentiation,and the difference was statistically significant(P<0.05).The ECOG score,the number of treatment lines,and the degree of tissue differentiation were independent risk factors for grade Ⅲ and Ⅳ adverse reactions.The ECOG score and the number of treatment lines were positively correlated with the Ⅲ and Ⅳ adverse reactions.The higher the ECOG score,The higher the number of treatment lines,the higher the incidence of adverse reactions of grade Ⅲ and Ⅳ.The degree of tissue differentiation was negatively correlated with the adverse reactions of grade Ⅲ and Ⅳ.The lower the degree of tissue differentiation,the higher the incidence of adverse reactions of grade Ⅲ and Ⅳ.P<0.05,and OR were in the 95%CI range of OR).Conclusion:The clinical efficacy of apatinib in the treatment of advanced gastric cancer was good,but the incidence of Ⅲ and Ⅳ degree AE were high during the treatment period.Hypertension and hand-foot syndrome were the main AE.High ECOG score,>2-line therapy and low tissue differentiation were the important risk factors for the occurrence of Ⅲ and Ⅳ AE.When apatinib is used in clinical treatment,it is necessary to take specific measures according to the patient’s condition to prevent AE. |
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