CODE方案密集周化疗和多学科综合治疗小细胞肺癌  

Patients with small-cell lung cancer managed with the CODE regimen of intensive weekly chemotherapy and multidisciplinary comprehensive therapy

作　　者：李龙芸[1] 王树兰[1] 王孟昭[1] 张福泉[2] 张志庸[3] 刘艳霞[1] 陈艳[1] 李俊蓉[1] 

机构地区：[1]中国医学科学院 北京协和医学院 北京协和医院呼吸内科,北京100730 [2]中国医学科学院 北京协和医学院 北京协和医院放疗科,北京100730 [3]中国医学科学院 北京协和医学院 北京协和医院胸外科,北京100730

出　　处：《癌症进展》2013年第2期106-115,共10页Oncology Progress

摘　　要：目的探讨CODE方案密集周化疗及多学科综合治疗小细胞肺癌(small cell lung cancer,SCLC)的疗效及生存预后因素。方法 1995年3月至2005年12月入组SCLC患者118例,其中男性86例(72.9%),女性32例(27.1%),中位年龄55岁,局限期(LD)30例(25.4%),广泛期(ED)88例(74.6%),所有患者均有病理或细胞学诊断。周化疗药物包括顺铂、长春新碱、阿霉素及依托泊苷,主要通过增加给药频率增加药物剂量强度,总疗程为9周。CODE方案疗效达CR或PR即可接受胸部放疗(RT),放疗后患者KPS>60,再行维持治疗(MCT)。11例患者于CODE前或后进行了手术。对CODE及综合治疗均按实体瘤疗效评定。应用Kaplan-Meier法绘制生存曲线,寿命表法计算生存率,COX多因素回归比例风险模型进行了生存预后因素分析。结果对110例患者进行了CODE疗效评定,其中CR 17例(15.5%),PR 79例(71.8%),PD 5例(4.5%),不良反应轻微。主要治疗模式是CODE+RT+MCT,总计83例(70%)。105例(89%)患者对CODE+多学科治疗有效,CR 29例(25%),PR76例(64%)。118例SCLC患者的中位生存期(MST)为21个月(95%CI:17.5～24.6),ED为17个月(95%CI:12.4～21.6),LD 38个月(95%CI:12.2～63.8),P=0.000。ED、LD 1年生存率分别为70.5%和93.3%(P=0.022),5年生存率为12.5%和40%(P=0.003)。单因素及COX多因素分析显示疗效、治疗模式及疾病分期与患者生存密切相关。结论 SCLC患者经CODE及多学科综合治疗生存明显延长。CODE方案是SCLC重要的内科治疗,且耐受性好。早期的SCLC可选择外科治疗。维持治疗的临床研究值得进一步探讨。Objective To retrospectively evaluate the efficacy and prognostic factors of the intensive weekly chemotherapy plus multidisciplinary comprehensive therapy for patients with small-cell lung cancer （ SCLC ）. Method 118 SCLC patients were recruited at PUMC hospital from March 1995 to December 2005, of which 30 patients （ 25.4% ） had limited-disease （LD） and 88 （74. 6% ） had extensive-disease （ ED）, 86 patients （72. 9% ） were male and 32 （27. 1% ） were female, the median age was 55 years old. The intensive weekly regimen with cisplatin, vincristine, doxorubicin, and et- oposide （CODE） was designed for all patients. The optimal dose intensity was attained through frequent administrations. The duration of chemotherapy was 9 weeks. Patients achieved CR or PR as per WHO criteria after chemotherapy were to receive thoracic radiotherapy （RT）. Patients with good performance status （KPS 〉 60） after RT followed by maintainence chemother- apy （MCT）. The surgical operations were performed for 11 patients. The survival was analyzed by Kaplan-Meicr and prog- nostic factors by COX multivariate regression. Result 1 l0 patients were evaluated in CODE regimen： 17 patients （15.5%） had CR disease, 79 patients （71.8%） had PR disease, and 5 patients （4. 5% ） had PD, no serious adverse event was found. 83 patients （70%） were treated with CODE ＋ RT ＋ MCT, 105 patients （89%） responded to CODE and muhidiscipli- nary comprehensive therapy, of that 29 patients （25%） attained CR and 76 patients （64%） achieved PR. The median overall survival was 21 months （95% CI： 17. 5-24. 6） in all patients, of which 17 months （95% CI： 12.4-21.6） in patients with ED and 38 months （95% CI： 12. 2 -63.8） （P =0. 000） in LD. One year survival rate of patients with ED and LD were 70. 5% and 93. 3% （P =0. 02） respectively. Five year survival rate of patients with ED and LD were 12.5% and 40% （ P = 0. 003 ） respectively. Monofactor and multifactor COX regress

关 键 词：小细胞肺癌 化学疗法 放射治疗 综合治疗 

分 类 号：R734.2[医药卫生—肿瘤]