依托泊苷联合铂类制剂治疗SCLC的疗效及预后相关因素分析
发布时间：2018-07-23 19:35
【摘要】：研究背景小细胞肺癌(small cell lung cancer,SCLC)占所有肺癌类型的15%～20%,是一类易于侵犯血管并早期肺门及纵隔淋巴结甚至远处转移的肺癌,进展较快,预后较差。这些特征与小细胞肺癌组织病理学类型相关。依托泊苷联合铂类制剂的化疗方案是目前SCLC化疗的一线治疗方案。化学治疗联合放射治疗为目前SCLC的治疗选择方案。SCLC患者个体间差异较大,治疗预后差异显著,获益悬殊。分析依托泊苷联合铂类制剂一线化疗的疗效及其他临床预后因素将有助于小细胞肺癌个体化治疗的发展。材料和方法收集2011年01月至2016年06月于山东大学附属省立医院呼吸内科就诊,通过组织活检,组织病理学结果可确诊为SCLC的患者。按照严格的纳入标准、排除标准来选择病例,最终纳入221例患者。通过病案查询,收集患者接受2次化疗后的病情评估、疾病无进展生存期及不良反应,以及性别、年龄、吸烟史、戒烟史、ECOG评分、肿瘤标志物NSE、病理免疫组化Ki-67、血钠浓度、治疗方案、是否联合放疗、化疗周期等临床信息。通过SPSS 22.0软件及GraphPad软件进行数据处理,卡方检验各因素与疗效的相关性,Log-rank法进行显著性检验。采用Kaplan-Meier法绘制患者的无进展生存期生存曲线以及单因素分析,有意义者纳入COX比例风险模型进行多因素分析,取p0.05有统计学意义。结果1、221例患者中,男女比例为2.2:1,年龄范围为26～82岁,局限期SCLC为108例,广泛期SCLC为113例。所有患者均接受了依托泊苷+铂类制剂化疗方案治疗,其中单纯化疗者为120例,放化疗结合者101例。187例化疗初次反应评估达CR/PR,34例为SD/PD。2、疾病分期、PS评分、Ki-67与患者依托泊苷联合铂类制剂化疗首次化疗疗效评估相关,局限期、PS评分低分组、Ki-67(-)～(++)组中患者首次化疗疗效评估有效率高,分别是91.7%、89%、96.8%。其中局限期(OR0.337 95%CI 0.127-0.896 P=0.029)、PS 评分(OR 1.956,95%CI 1.004-3.808,p=0.049)为其独立预后因素。Ki-67需要结合其他指标综合判断其首次化疗疗效评估及预后。3、从无进展生存期来看,PS评分低(p=0.0122)、血钠正常组(p=0.0065)、化疗周期≥4个周期(p0.0001)、放化疗联合组(p0.0001)、首次化疗疗效评估CR+PR(p0.0001)的无进展生存期显著较长。但COx回归分析中,结果示性别、年龄、PS评分、治疗模式、化疗周期、血钠、化疗疗效首次评估等均不是小细胞肺癌的独立预后因素。结论1、局限期、PS评分0～1分、Ki-67(-)～(++)组中患者首次化疗疗效评估有效率高,其中局限期、PS评分0-1是首次化疗疗效评估的独立预后因素,Ki-67需要结合其他指标综合判断。2、PS评分0～1分、无低钠血症、放化疗联合治疗、化疗周期≥4个周期、首次化疗疗效评估CR/PR者无进展生存期显著较长。
[Abstract]:Background small cell lung cancer (small cell lung cancer) is a kind of lung cancer which is prone to invasion of blood vessels and metastasis of early hilar and mediastinal lymph nodes. These characteristics are related to the histopathological types of small cell lung cancer. Etoposide combined with platinum is the first-line chemotherapy regimen for SCLC. Chemotherapy combined with radiotherapy is the current treatment option for SCLC patients. To analyze the therapeutic effect of etoposide combined with platinum preparation and other clinical prognostic factors will contribute to the development of individual therapy for small cell lung cancer. Materials and methods patients with SCLC were collected from January 2011 to June 2016 in the Department of Respiratory Medicine affiliated to Shandong University. Select cases according to strict inclusion criteria, exclusion criteria, and eventually 221 patients. According to the inquiry of medical records, we collected the evaluation of patients' condition after two times of chemotherapy, the disease survival time and adverse reaction, sex, age, smoking history, history of smoking cessation, score of ECOG, tumor marker NSE, pathological immunohistochemical Ki-67, serum sodium concentration. Treatment plan, whether the combination of radiotherapy, chemotherapy cycle and other clinical information. The data were processed by SPSS 22.0 software and GraphPad software. The correlation between factors and curative effect was tested by Chi-square method and Log-rank method. The Kaplan-Meier method was used to draw the survival curve and single factor analysis. The significant subjects were included in the COX proportional risk model for multivariate analysis. Results in 1221 cases, the ratio of male to female was 2.2: 1, the age range was 2682.108 cases of partial SCLC and 113 cases of extensive SCLC. All the patients were treated with etoposide platinum preparation chemotherapy regimen, 120 of them were treated with chemotherapy alone. The initial response of 101 patients with chemotherapy combined with radiotherapy and chemotherapy was assessed to be 34 cases of CRP / PRN as SD-PD.2.The score of Ki-67 was correlated with the evaluation of the first chemotherapy effect of etoposide combined with platinum preparation. In the group of Ki-67 (-) ~ (-), the effective rate of the first chemotherapy was 91.7% and 96.8%, respectively. OR0.337 95%CI 0.127-0.896 P0. 029) PS score (OR 1. 95695) is the independent prognostic factor. Ki-67 needs to be combined with other indicators to evaluate the efficacy and prognosis of the first chemotherapy. The PS score is low (p0. 0122), the blood natrium is normal (p0. 0065), and chemotherapy is necessary. The progression-free survival time was significantly longer in the combination of radiotherapy and chemotherapy group (p0.0001) than in the first chemotherapy group (p0.0001). The first time chemotherapy was used to evaluate the efficacy of CR PR (p0.0001. However, the results of COx regression analysis showed that sex, age and PS score, treatment mode, chemotherapy cycle, blood sodium and the first evaluation of chemotherapy efficacy were not independent prognostic factors of small cell lung cancer. Conclusion 1. The effective rate of the first chemotherapy in the group of limited PS score 0 ~ 1 and Ki-67 (-) ~ (-) was higher than that in the control group. PS score 0-1 was an independent prognostic factor in the evaluation of the efficacy of the first chemotherapy. Ki-67 should be combined with other indexes to judge the score of 0 ~ 1, no hyponatremia, combined radiotherapy and chemotherapy, and chemotherapy cycle 鈮，
本文编号：2140434
[Abstract]:Background small cell lung cancer (small cell lung cancer) is a kind of lung cancer which is prone to invasion of blood vessels and metastasis of early hilar and mediastinal lymph nodes. These characteristics are related to the histopathological types of small cell lung cancer. Etoposide combined with platinum is the first-line chemotherapy regimen for SCLC. Chemotherapy combined with radiotherapy is the current treatment option for SCLC patients. To analyze the therapeutic effect of etoposide combined with platinum preparation and other clinical prognostic factors will contribute to the development of individual therapy for small cell lung cancer. Materials and methods patients with SCLC were collected from January 2011 to June 2016 in the Department of Respiratory Medicine affiliated to Shandong University. Select cases according to strict inclusion criteria, exclusion criteria, and eventually 221 patients. According to the inquiry of medical records, we collected the evaluation of patients' condition after two times of chemotherapy, the disease survival time and adverse reaction, sex, age, smoking history, history of smoking cessation, score of ECOG, tumor marker NSE, pathological immunohistochemical Ki-67, serum sodium concentration. Treatment plan, whether the combination of radiotherapy, chemotherapy cycle and other clinical information. The data were processed by SPSS 22.0 software and GraphPad software. The correlation between factors and curative effect was tested by Chi-square method and Log-rank method. The Kaplan-Meier method was used to draw the survival curve and single factor analysis. The significant subjects were included in the COX proportional risk model for multivariate analysis. Results in 1221 cases, the ratio of male to female was 2.2: 1, the age range was 2682.108 cases of partial SCLC and 113 cases of extensive SCLC. All the patients were treated with etoposide platinum preparation chemotherapy regimen, 120 of them were treated with chemotherapy alone. The initial response of 101 patients with chemotherapy combined with radiotherapy and chemotherapy was assessed to be 34 cases of CRP / PRN as SD-PD.2.The score of Ki-67 was correlated with the evaluation of the first chemotherapy effect of etoposide combined with platinum preparation. In the group of Ki-67 (-) ~ (-), the effective rate of the first chemotherapy was 91.7% and 96.8%, respectively. OR0.337 95%CI 0.127-0.896 P0. 029) PS score (OR 1. 95695) is the independent prognostic factor. Ki-67 needs to be combined with other indicators to evaluate the efficacy and prognosis of the first chemotherapy. The PS score is low (p0. 0122), the blood natrium is normal (p0. 0065), and chemotherapy is necessary. The progression-free survival time was significantly longer in the combination of radiotherapy and chemotherapy group (p0.0001) than in the first chemotherapy group (p0.0001). The first time chemotherapy was used to evaluate the efficacy of CR PR (p0.0001. However, the results of COx regression analysis showed that sex, age and PS score, treatment mode, chemotherapy cycle, blood sodium and the first evaluation of chemotherapy efficacy were not independent prognostic factors of small cell lung cancer. Conclusion 1. The effective rate of the first chemotherapy in the group of limited PS score 0 ~ 1 and Ki-67 (-) ~ (-) was higher than that in the control group. PS score 0-1 was an independent prognostic factor in the evaluation of the efficacy of the first chemotherapy. Ki-67 should be combined with other indexes to judge the score of 0 ~ 1, no hyponatremia, combined radiotherapy and chemotherapy, and chemotherapy cycle 鈮，
本文编号：2140434
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