铂类为基础的双药二线治疗方案对NSCLC患者预后的影响及其相关因素分析

doi:10.3760/cma.j.issn.1673422X.2018.05.003

摘要/Abstract

摘要： 目的分析以铂类为基础的双药二线治疗方案对于晚期非小细胞肺癌（NSCLC）患者预后的影响及其相关因素。方法选取2014年1月至2016年12月在我院接受治疗的80例晚期NSCLC患者作为研究对象，利用随机数字表法将入选患者随机分为单药组与双药组，每组40例。单药组患者采取多西他赛或培美曲塞进行化疗，而双药组患者则采取多西他赛、培美曲塞、长春瑞滨及紫杉醇等联合铂类（顺铂）双药治疗。比较两组患者的治疗效果并分析二线化疗对患者预后的影响因素。结果双药组患者治疗缓解率显著高于单药组（45.0%∶20.0%，χ2=4.493，P=0.021）。对双药组患者进行单因素分析，结果显示病理类型（χ2=7.511，P=0.023）、一二线治疗间隔时间（χ2=6.412，P=0.041）、二线基线TNM分期（χ2=4.022，P=0.045）、二线周期数（χ2=5.065，P=0.027）、白细胞下降（χ2=4.852，P=0.033）以及神经元特异性烯醇化酶（χ2=9.243，P=0.002）是影响二线化疗预后的主要因素。对双药组患者进行多因素分析，结果显示一二线治疗间隔时间（OR=3.511，95%CI为1.486～3.602，P=0.033）、二线基线TNM分期（OR=1.623，95%CI为1.127～2.119，P=0.027）、二线周期数（OR=2.208，95%CI为1.589～2.827，P=0.014）以及神经元特异性烯醇化酶（OR=1.960，95%CI为1.209～2.773，P=0.025）是影响二线化疗预后的独立危险因素。结论以铂类为基础的双药二线治疗方案对NSCLC患者的病情缓解效果好，且一二线治疗间隔、二线基线TNM分期、二线周期数以及神经元特异性烯醇化酶是影响预后的危险因素。

关键词: 癌, 非小细胞肺, 药物疗法, 铂化合物, 抗肿瘤联合化疗方案, 影响因素

Abstract: ObjectiveTo analyze the prognostic implications of secondline double drug regimens for advanced nonsmall cell lung cancer (NSCLC) patients and related factors. MethodsEighty patients with advanced NSCLC who were accepted from January 2014 to December 2016 in our hospital were chosen as the research objects. The patients were randomly divided into two groups using the random number table method, namely single drug group (n=40) and double drug group (n=40). The patients in single drug group were treated with docetaxel or pemetrexed, and the patients in double drug group were treated with docetaxel, pemetrexed, vinorelbine or paclitaxel combined with platinum (cisplatin). The effects of patients in the two groups were compared and the factors affecting the prognosis of the patients were analyzed. ResultsThe remission rate in the double drug group was significantly higher than that in the single drug group (45.0% vs. 20.0%; χ2=4.493, P=0.021). The results of single factor analysis for patients in double drug group showed that pathological type (χ2=7.511, P=0.023), time from firstline treatment to secondline treatment (χ2=6.412, P=0.041), secondline baseline TNM stage (χ2=4.022，P=0.045), secondline cycle number (χ2=5.065，P=0.027), leukopenia (χ2=4.852, P=0.033) and neuron specific enolase (χ2=9.243, P=0.002) were the main prognostic factors of the secondline chemotherapy. The results of multivariate analysis for patients in double drug group showed that time from firstline treatment to secondline treatment (OR=3.511, 95%CI: 1.4863.602, P=0.033), secondline baseline TNM stage (OR=1.623, 95%CI: 1.1272.119, P=0.027), secondline cycle number (OR=2.208, 95%CI: 1.5892.827, P=0.014) and neuron specific enolase (OR=1.960, 95%CI: 1.2092.773, P=0.025) were independent prognostic factors. ConclusionThe remission effect of double secondline treatment scheme based on platinum for patients with NSCLC is good, and the time form firstline treatment to secondline treatment, secondline baseline TNM stage, secondline cycle number and neuron specific enolase are independent prognostic factors.

Key words: Carcinoma, non-small-cell lung, Drug therapy, Platinum compounds, Antineoplastic combined chemotherapy protocols, Influencing factors

王大中. 铂类为基础的双药二线治疗方案对NSCLC患者预后的影响及其相关因素分析[J]. 国际肿瘤学杂志, 2018, 45(5): 269-272.

Wang Dazhong. Effect of platinum based dual drug secondline therapy on prognosis of NSCLC patients and relative factors analysis[J]. Journal of International Oncology, 2018, 45(5): 269-272.

参考文献

［1］白丽艳, 祁玉娟. 晚期非小细胞肺癌化疗新进展［J］. 中国现代医药杂志, 2016, 18(7): 99102. DOI: 10.3969/j.issn.16729463.2016.07.035. ［2］程春来. 化疗联合DCCIK方案治疗非小细胞肺癌的疗效分析［J］. 实用癌症杂志, 2015, 30(5): 759761. DOI: 10.3969/j.issn.10015930.2015.05.040. ［3］ Inoue A, Suzuki T, Fukuhara T, et al. Prospective phase Ⅱ study of gefitinib for chemotherapynaive patients with advanced nonsmallcell lung cancer with epidermal growth factor receptor gene mutations［J］. J Clin Oncol, 2006, 24(21): 33403346. DOI: 10.1200/JCO.2005.05.4692. ［4］ Hanna N, Shepherd FA, Fossella FV, et al. Randomized phase Ⅲ trial of pemetrexed versus docetaxel in patients with nonsmallcell lung cancer previously treated with chemotherapy［J］. J Clin Oncol, 2004, 22(9): 15891597. DOI: 10.1200/JCO.2004.08.163. ［5］吴姗姗, 严峰, 邓玉玲, 等. 小细胞和非小细胞肺癌晚期患者CD3+ CD4+及CD3+ CD8+ T淋巴细胞亚群的差异［J］. 中国免疫学杂志, 2015, 31(1): 114116, 121. DOI: 10.3969/j.issn.1000484X.2015.01.024. ［6］王恩华, 朱明华, 步宏, 等. 非小细胞肺癌靶向药物治疗相关基因检测的规范建议［J］. 中华病理学杂志, 2016, 45(2): 7377. DOI: 10.3760/cma.j.issn.05295807.2016.02.001. ［7］崔月倩, 胡毅. 依维莫司联合化疗或靶向药物治疗晚期非小细胞肺癌的临床疗效和安全性［J］. 现代肿瘤医学, 2016, 24(24): 39203923. DOI: 10.3969/j.issn.16724992.2016.24.011. ［8］郑积华, 林金容, 谢波, 等. 培美曲塞与多西他赛二线随机分组治疗晚期非小细胞肺癌对比分析［J］. 中华肿瘤防治杂志, 2013, 20(5): 368370. DOI: 10.16073/j.cnki.cjcpt.2013.05.016. ［9］ Thatcher N, Chang A, Parikh P, et al. Gefitinib plus best supportive care in previously treated patients with refractory advanced nonsmallcell lung cancer: results from a randomised, placebocontrolled, multicentre study (Iressa Survival Evaluation in Lung Cancer)［J］. Lancet, 2005, 366(9496): 15271537. DOI: 10.1016/S01406736(05)676258. ［10］金静思, 贺巾钊, 周黎明. 非小细胞肺癌分子靶向治疗药物的现状及进展［J］. 中国肿瘤临床, 2015, 42(17): 881885. DOI: 10.3969/j.issn.10008179.2015.17.714. ［11］ Bell DW, Lynch TJ, Haserlat SM, et al. Epidermal growth factor receptor mutations and gene amplification in nonsmallcell lung cancer: molecular analysis of the IDEAL/INTACT gefitinib trials［J］. J Clin Oncol, 2005, 23(31): 80818092. DOI: 10.1200/JCO.2005.02.7078. ［12］姜忠于, 胡春秀, 刘学武, 等. 靶向药物治疗对表皮生长因子受体基因不同位点突变的非小细胞肺癌患者预后影响［J］. 中国临床药理学杂志, 2015, 31(23): 23062308. DOI: 10.13699/j.cnki.10016821.2015.23.009. ［13］林动, 许凌, 林景辉, 等. 埃克替尼一线治疗EGFR敏感性突变的晚期非小细胞肺癌的疗效观察［J］. 实用肿瘤杂志, 2015, 30(3): 220224. DOI: 10.13267/j.cnki.syzlzz.2015.03.007. ［14］ Miller VA. Optimizing therapy in previously treated nonsmall cell lung cancer［J］. Semin Oncol, 2006, 33(1 Supple 1): S2531. DOI: 10.1053/j.seminoncol.2005.12.005. ［15］王宝强, 周陈华. 紫杉醇联合顺铂同步放化疗治疗局部晚期非小细胞肺癌的临床疗效及安全性评价［J］. 中国临床药理学杂志, 2015, 31(8): 603605. DOI: 10.13699/j.cnki.10016821.2015.08.006. ［16］马亚梅. 培美曲塞联合顺铂治疗晚期非小细胞肺癌的疗效观察［J］. 实用癌症杂志, 2015, 30(2): 205207. DOI: 10.3969/j.issn.10015930.2015.02.015. ［17］孔倩, 王心悦, 蒋日成, 等. 不同二线方案治疗178例晚期非小细胞肺癌的预后及影响因素［J］. 中华肿瘤杂志, 2016, 38(4): 294299. DOI: 10.3760/cma.j.issn.02533766.2016.04.010.

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