长春瑞宾单药与长春瑞宾联合卡铂治疗≥75岁的老年晚期非小细胞肺癌患者的临床研究  

Vinorelbine versus vinorelbine-carboplatin in treatment of elderly patients with advanced non-small cell lung cancer

作　　者：李爱武[1] 周彩存[1] 徐建芳[1] 任胜祥[1] 陈晓霞[1] 朱韧[1] 

机构地区：[1]同济大学附属肺科医院肿瘤科,上海200433

出　　处：《同济大学学报（医学版）》2012年第4期57-62,共6页Journal of Tongji University(Medical Science)

摘　　要：目的探讨长春瑞宾与长春瑞宾联合卡铂在治疗≥75岁的老年晚期(Ⅲb或Ⅳ期)非小细胞肺癌(non-small cell lung cancer,NSCLC)中的有效性和安全性。方法回顾性分析细胞学或组织学确诊的51例≥75岁的初治晚期NSCLC患者,长春瑞宾单药治疗或长春瑞宾联合卡铂治疗,比较两种方案的有效性和安全性。结果 51例患者共接受了105个周期的化疗,平均化疗周期数约为2.1个,其中单药组为1.9个,联合组为2.3个(P=0.295)。两组可评价疗效的患者分别为21例和14例,单药组部分缓解率(partial remission,PR)为9.5%,联合组为28.6%;两组的中位生存时间分别为为7.2个月(95%CI 4.9,9.5)和9.3个月(95%CI 4.3,15.7),1,2年生存率分别为39.7%、10%和45.0%、13.0%(Log Rank P=0.679)。多因素分析提示,相对于功能状态(performancestatus,PS)评分=1的患者,PS=2患者1年生存期率较低(29.1%vs 45.5%,P=0.061)。在安全性方面,两组的药物毒副反应均较轻,无Ⅳ级不良反应,主要的毒副反应是血液学毒性,其中Ⅲ度血液学毒性分别为中性粒细胞下降(6.5%,15.0%),白细胞下降(6.5%,10.0%),贫血(6.5%,5.0%)和血小板下降(3.2%,5.0%),非血液学毒性主要为Ⅰ、Ⅱ度的胃肠道反应,两组间的毒副反应无统计学差异。多因素COX回归分析显示,PS=2和重度合并症的患者可能较PS=0-1和轻度合并症患者的预后差(P=0.061,0.183)。结论尽管尚无统计学差异,相对于长春瑞宾单药,长春瑞宾联合卡铂方案在治疗≥75岁晚期NSCLC疗效上略有优势;PS评分和合并症状态可能是影响生存期的主要因素。Objective To evaluate the efficacy and safety of vinorelbine versus vinorelbine- carboplatin in elderly patients with advanced non-small cell lung cancer （NSCLC）. Methods The clinical characteristics, treatment strategies and survival features of 51 elderly patients （≥75years） with NSCLC admitted between January 2006 to December 2008 were retrospectively analyzed. Results The mean therapeutic cycles of vinorelbine and vinorelbine-carboplatin group were 1.9 and 2.3respectively （ P = 0. 295 ）. Among 21 and 14 efficacy-evaluable patients in each group, the partial remission （PR） rates were 9.5% and 28.6% respectively（P =0. 191 ） ; the median survival time were 7.2 （95% CI： 4.9, 9.5） months and 9.3 （95%CI： 4.3, 15.7） months; and the 1,2-year survival rates were 39.7% ,10% and 45.0% ,13% （Log Rank P =0. 679）. Cox regression analysis shows that patients with performance status （PS） = 2 and severe comorbidities had a poorer prognosis than those with PS =0 -1 and mild comorbidities （P = 0. 061, 0. 183 ）. No grade 4 hematological toxicity was found, the grade 3 hematological toxicities of two groups were neutropenia （ 6. 5%, 15. 0% ）, leukopenia（6.5% ,10.0% ）, anemia（6.5% ,5.0% ） and thrombopenia （3.2% ,5.0% ）. Only grade 1-2 non-hematological toxicities were recorded. And no differences of toxicity profiles were found between the two groups. Conclusion Compared with single agent, vinorelbine-carboplatin seems to be a feasible treatment option with a favorable toxicity profile for elderly （ ≥ 75years） patients with advanced NSCLC. PS status and comorbidities may be the most important prognostic factors.

关 键 词：老年 非小细胞肺肿瘤 长春瑞宾 卡铂 

分 类 号：R734.2[医药卫生—肿瘤]