晚期非小细胞肺癌二线两药联合化疗对比单药的回顾性分析

发布时间：2018-06-30 00:31

本文选题：非小细胞肺癌 + 二线化学治疗　；参考：《济南大学》2017年硕士论文

【摘要】：目前当今世界范围内肺癌依然是肿瘤死亡的首要原因。其中80%~85%的病例诊断为非小细胞肺癌(NSCLC)。两药联合化疗,尤其是以铂类为基础的两药联合,代表一线晚期NSCLC患者的标准方案。目前指南推荐的二线用药主要是多西他赛、培美曲塞、TKI。多西他赛、培美曲塞单药化疗在二线化疗中的临床疗效差强人意,其客观缓解率仅为10%,中位生存期只有8个月。目前急需更好的治疗来提高晚期非小细胞肺癌二线化疗疗效。目的目前,中国国内非小细胞肺癌二线临床应用两药联合化疗方案较普遍。本研究通过回顾性分析、比较联合方案和单药方案二线治疗晚期非小细胞肺癌的疗效、不良反应,探讨联合方案二线治疗晚期非小细胞肺癌的有效性、安全性,为晚期非小细胞肺癌患者二线方案的选择提供依据。方法我们的研究回顾性收集2011年1月至2015年4月在五家医院(山东省肿瘤医院、章丘市人民医院、济钢总医院、泰山医学院附属医院、郓城县人民医院)晚期非小细胞肺癌一线含铂方案治疗后接受二线单药和两药联合化疗方案的病例。分析比较两组患者的有效率(RR)、疾病控制率(DCR)、无进展生存期(PFS)、总生存期(OS)和治疗相关不良反应。采用SPSS17.0软件对数据进行处理,P0.05为差异有统计学意义。结果235名患者接受两药联合化疗,73名患者接受单药治疗。RR在联合治疗组28.5%,单药组9.6%(p=0.001)。PFS有显著性差异,联合组是4.9个月,单药组3.3个月(p=0.000)。OS联合组明显优于单药组(中位值,13.1和9.3个月;p=0.005)。多西他赛亚组分析结果显示:多西他赛单药组患者中位OS为7.9个月,多西他赛联合铂类组患者中位OS为12.6个月,P=0.0950.05。治疗间隔亚组分析显示治疗间隔超过6个月的两组患者OS有统计学差异(P=0.009)。多因素分析显示,年龄(p=0.008),ECOG评分(p0.001)和后续治疗(p0.001)对于总生存期OS是独立的预后因素。两组之间的III/IV级毒性反应中白细胞减少、中性粒细胞减少和血小板减少,恶心/呕吐和腹泻在联合治疗组更频繁。但是两组之间统计学没有任何显著差异。结论1.晚期非小细胞肺癌二线联合化疗较为普遍。2.联合化疗方案相较单药方案能够明显提高晚期非小细胞肺癌患者二线治疗的RR、DCR、PFS和OS,主要是治疗间隔超过6个月的患者。并且不会增加化疗相关毒副反应,患者耐受性良好。3.对于那些治疗间隔长、较年轻、ECOG评分好的患者,二线选择两药方案是一个好的选择。
[Abstract]:Lung cancer is still the leading cause of cancer death worldwide. Eighty percent of the cases were diagnosed as non-small cell lung cancer (NSCLC). Combination chemotherapy, especially platinum-based chemotherapy, represents the standard regimen for first-stage advanced NSCLC patients. The current second-line drug recommended by the guidelines is docetaxel, pemetrexide TKI. The clinical efficacy of docetaxel and pemetrexide in second line chemotherapy was not satisfactory. The objective remission rate was only 10 and the median survival time was only 8 months. Better treatment is urgently needed to improve the efficacy of second-line chemotherapy for advanced non-small cell lung cancer. Objective at present, two-drug combined chemotherapy regimen for non-small cell lung cancer (NSCLC) is common in China. By retrospective analysis, the efficacy and safety of combined regimen and single-drug regimen in the treatment of advanced non-small cell lung cancer (NSCLC) were compared, and the efficacy and safety of the combined regimen in the treatment of advanced NSCLC were discussed. To provide a basis for the selection of two-line regimen in patients with advanced non-small cell lung cancer (NSCLC). Methods five hospitals (Shandong Cancer Hospital, Zhangqiu people's Hospital, Jigang General Hospital, Taishan Medical College affiliated Hospital) were collected retrospectively from January 2011 to April 2015. Yuncheng County people's Hospital) patients with advanced non-small cell lung cancer received two-line single and two-drug combination chemotherapy regimen after first-line platinum-containing regimen. The response rate (RR), disease control rate (DCR), progression-free survival (PFS), total survival (OS) and treatment-related adverse reactions were analyzed and compared between the two groups. SPSS 17.0 software was used to process the data. Results 235 patients received two drugs combined with chemotherapy and 73 patients received monotherapy. RR was 28.5in the combined treatment group. There was a significant difference in the single drug group (9.6% (pt0.001) .PFS), and the combination group was 4.9 months old. The single drug group was significantly better than the single drug group in 3.3 months (p0. 000). OS combined group (median value 13. 1 and 9. 3 months, p0. 005). The results showed that the median OS of docetaxel group was 7.9 months, and that of docetaxel combined with platinum group was 12.6 months. The subgroup analysis showed that there was a significant difference in OS between the two groups (P0. 009). Multivariate analysis showed that age (p0. 008) and follow-up therapy (p0. 001) were independent prognostic factors for total survival OS. Leucopenia, neutropenia, thrombocytopenia, nausea / vomiting, and diarrhoea were more frequent in the combined treatment group. But there was no significant statistical difference between the two groups. Conclusion 1. Second line combined chemotherapy is more common in advanced non-small cell lung cancer (NSCLC). Compared with the single chemotherapy regimen, the combination chemotherapy regimen could significantly improve the RRDCRP PFS and OS in patients with advanced non-small cell lung cancer (NSCLC) treated with second line therapy, mainly in patients whose treatment interval was more than 6 months. And no increase in chemotherapy-related side effects, patients with good tolerance. 3. For those with longer treatment intervals and younger ECOG scores, the two-line regimen is a good choice.
【学位授予单位】：济南大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2

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