国际肿瘤学杂志

国际肿瘤学杂志 ›› 2017, Vol. 44 ›› Issue (8): 578-582.doi: 10.3760/cma.j.issn.1673-422X.2017.08.005

• 论著 • 上一篇    下一篇

胸腔热灌注化疗治疗肺癌胸腔积液的临床观察

张峻青, 王军成, 张改英, 陈静, 吴铁鹰   

  1. 030001太原，中国人民解放军第264医院肿瘤科
  • 出版日期:2017-08-08 发布日期:2017-07-21
  • 通讯作者: 张峻青，Email: zhangjunqing0@126.com E-mail:zhangjunqing0@126.com
  • 基金资助:

    全军青年培育项目(13QNP016)

Clinical observation of intrapleural hyperthermic perfusion chemotherapy for patients with malignant pleural effusion caused by lung cancer

Zhang Junqing, Wang Juncheng, Zhang Gaiying, Chen Jing, Wu Tieying   

  1. Department of Oncology, the 264th Hospital of PLA, Taiyuan 030001, China
  • Online:2017-08-08 Published:2017-07-21
  • Contact: Zhang Junqing, Email: zhangjunqing0@126.com E-mail:zhangjunqing0@126.com
  • Supported by:

    Youth Cultivation Project of the Chinese People′s Liberation Army (13QNP016)

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摘要： 目的  观察胸腔热灌注化疗对比胸腔置管化疗治疗肺癌所致恶性胸腔积液的临床疗效及不良反应。方法  纳入103例肺癌胸腔积液患者，胸腔热灌注化疗组65例，胸腔置管化疗组38例。观察胸腔积液控制率、胸腔积液进展时间、胸腔积液中血管内皮生长因子（VEGF）浓度与疗效的关系以及不良反应发生情况。结果  热灌注化疗组和置管化疗组的胸腔积液控制率分别为81.5%和52.6%，差异有统计学意义(χ2=9.834，P=0.002)。两组患者的中位胸腔积液进展时间分别为3.10个月和2.15个月，差异有统计学意义（χ2=10.512，P=0.001）。胸腔积液中VEGF低浓度患者接受胸腔热灌注化疗和腔内置管化疗后的中位胸腔积液进展时间分别为3.34个月和2.20个月，差异有统计学意义（χ2=9.409，P=0.002），但VEGF高浓度亚组，两种治疗方法的中位胸腔积液进展时间分别为2.85个月和2.10个月，差异无统计学意义（χ2=2.429，P=0.119）。两组患者的不良反应主要为消化道不良反应、乏力及血液毒性，热灌注化疗组患者乏力较置管化疗组常见（67.7%∶13.2%;χ2=28.595，P＜0.001）。 结论  胸腔热灌注化疗治疗肺癌所致恶性胸腔积液较常规腔内置管化疗提高了胸腔积液控制率，且可延长胸腔积液进展时间，不良反应易于耐受，胸腔积液进展时间延长在胸腔积液VEGF低浓度亚组中尤为明显，VEGF可作为胸腔热灌注化疗的疗效预测因素。

关键词: 肺肿瘤, 高温, 诱发, 胸腔积液, 恶性, 血管内皮生长因子类

Abstract: Objective  To observe the efficacy and adverse reaction of intrapleural hyperthermic perfusion and intrapleural chemotherapy for patients with malignant pleural effusion (MPE) caused by lung cancer. Methods  A total of 103 patients with MPE caused by lung cancer were assigned into one of two groups: intrapleural hyperthermic perfusion group (n=65) and intrapleural chemotherapy group (n=38). The disease control rate, MPE progress free survival, the relationship between vascular endothelial growth factor (VEGF) concentration in pleural effusion and curative effect and adverse reactions were observed.Results  The overall disease control rate in intrapleural hyperthermic perfusion group and intrapleural chemotherapy group was 81.5% and 52.6% respectively, with a significant difference (χ2=9.834, P=0.002). The median MPE progress free survival of the two groups was 3.10 and 2.15 months respectively, with a significant difference (χ2=10.512,P=0.001). A significant difference of the median MPE progress free survival was observed in low VEGF concentration subgroup between intrapleural hyperthermic perfusion and intrapleural chemotherapy (3.34 months vs. 2.20 months; χ2=9.409, P=0.002), but no difference was observed in high VEGF expression subgroup (2.85 months vs. 2.10 months; χ2=2.429, P=0.119). The main adverse reactions included gastrointestinal adverse reaction, fatigue and hematotoxicity. Fatigue occurred in intrapleural hyperthermic perfusion group more commonly compared with intrapleural chemotherapy group (67.7% vs. 13.2%; χ2=28.595, P＜0.001). Conclusion  Compared with intrapleural chemotherapy, intrapleural hyperthermic perfusion can better improve disease control rate and MPE progress free survival in MPE patients caused by lung cancer, and it′s adverse reactions are tolerated easily. The MPE progress free survival prolonging is observed especially in VEGF low expression subgroup. VEGF level in pleural effusions maybe could predict efficacy of intrapleural hyperthermic perfusion.

Key words: Lung neoplasms, Hyperthermia, induced, Pleural effusion, malignant, Vascular endothelial growth factors