目的比较5种含铂两药方案一线治疗晚期非小细胞肺癌的疗效,并进一步探讨影响患者预后的可能因素。方法回顾性分析352例Ⅲ/Ⅳ期NSCLC患者第3代含铂方案一线化疗的临床资料。主要化疗方案为TP方案、DP方案、LP方案、GP方案和PP方案,每3周1次。主要观察指标为客观有效率,疾病控制率,无进展生存期,总生存期和毒副作用。结果全组患者的中位年龄为59岁。整体一线化疗的有效率为36.36%,疾病控制率为69.03%,中位无进展生存期为7个月,中位生存期为13个月。各化疗方案组有效率、疾病控制率、无进展生存期及总生存期的比较差异均无统计学意义(P〉0.05)。紫杉醇联合顺铂方案Ⅲ~Ⅳ级血液学副作用发生率比多西他赛联合顺铂方案或紫杉醇脂质体联合顺铂方案高,差异有显著统计学意义(P〈0.05)。分层分析发现,年龄与病理类型或许对择优用药有指导意义。Cox回归多因素分析显示:ECOG评分较低(0分)、临床分期较好(Ⅲ期)、化疗周期〉4周期、接受过二线化疗、一线化疗有效或获得疾病控制的患者预后更好(P〈0.05)。结论 5种化疗方案之间有效率、疾病控制率、无进展生存期及总生存期的比较无明显差异。多西他赛、紫杉醇脂质体Ⅲ~Ⅳ级血液学副作用发生率比紫杉醇低。治疗前ECOG评分、临床分期、化疗周期,是否进行二线化疗和一线化疗后疗效是晚期NSCLC含铂两药方案一线化疗后的独立预后因素。
Objective To compare the efficacy of 5 kinds of platinum-based chemotherapy regimens in the first-line treatment of advanced non-small cell lung cancer (NSCLC), and to further explore the possible ways to improve the prognosis. Methods A retrospective study was conducted and included the clinical data of 352 patients (mean age 59) with stage Ⅲ and Ⅳ NSCLC. The patients received the third generation new drug-based platinum regimens, including 5 kinds of regimens, TP, DP, LP, GP, and PP. The primary endpoint was objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS) and overall survival (OS). Results The overall objective response rate was 36.36% and disease control rate was 69.03%. The median PFS was 7 months and the median OS was 13 months. There was no statistically significant difference in ORR , DCR, PFS, and OS among the 5 groups (P〉0.05). The incidence of grade 3 to 4 hematologic toxicity was significantly higher in the patients received TP regimens (P〈0.05). Stratified analysis showed that age and pathology perhaps guide preferential treatment. COX model regression analysis showed that ECOG PS, tumor stage, chemotherapy cycles, objective response rate, disease control rate and second-line chemotherapy had independent prognostic significance (P〈0.05), but sex, age, pathology types and smoking had not. Conclusion The efficacy of the 5 platinum-based chemotherapy regimens in the treatment of NSCLC does not show any statistical difference. The incidence of grade 3 to 4 hematologic toxicity is significantly higher in the patients received TP regimen. The ECOG PS, tumor stage, chemotherapy cycles, effect after first-line chemotherapy and second-line chemotherapy are of independent prognostic significance.