合并症对晚期老年肿瘤患者一线化疗疗效和预后的影响  

The impact of comorbidity on response and prognosis of elder cancer patients treated with first line chemotherapy

作　　者：周艳萍[1] 管梅[1] 陈书长[1] 张晓红[1] 王艳静[1] 沙蕊[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肿瘤内科,100032

出　　处：《北京医学》2014年第5期362-366,共5页Beijing Medical Journal

摘　　要：目的分析合并症对晚期老年肿瘤患者一线化疗疗效和预后的影响。方法对北京协和医院从2008—2012年收治的≥60岁晚期肿瘤患者进行回顾性研究。根据合并症情况分为无合并症、一般合并症和严重合并症3组：慢性疾病不影响重要脏器功能定义为一般合并症，重要脏器功能明显障碍定义为严重合并症。结果127例一线化疗的晚期肿瘤患者。中位年龄为67岁（60～85岁）．完成了621个周期化疗，中位数为4个周期（1～9个周期）。无合并症（n=48例）、一般合并症（n=52例）、严重合并症（n=27例）3组的肿瘤控制率（包括部分缓解和疾病稳定者）分别为67％、64％和63％。一般合并症组与无合并症组相比，化疗剂量强度和毒副反应相当，无进展时间分别为9．31个月和8．56个月。严重合并症组平均化疗剂量强度为标准的（68．4±19．9）％，低于前两组（P=0．038）；无进展生存期为5．34个月，较前两组均明显缩短（P=0．02）。结论老年晚期肿瘤患者可以接受联合方案的一线化疗，合并症不影响患者的肿瘤控制率。有一般合并症的患者可以采用常规联合方案的化疗．严重合并症的患者是否联合方案化疗应慎重．化疗剂量应该进行适当调整，并且密切监测不良反应。Objective To assess the role of comorbidity on treatment response and prognosis of elder cancer patients treated with first line chemotherapy. Methods Cancer patients older than 60 years treated with chemotherapy from 2008 to 2012 in Peking Union Medical College Hospital were retrospectively reviewed. Results One hundred and twenty-seven elder cancer patients, with a mean age of 67 years old, were analyzed. They were divided into three groups： no comorbidity group （n=48）, mild comorbidity group （n=52） and serious comorbidity group （n=27）. The disease response rate （DRR） was 67% ,64% and 63% in the three groups. There was no difference in the progress of free survival （PFS） between no eomorbidity group and mild eomorbidity group （9.31 vs. 8.56 months）. While the PFS was shorter in serious comorbidity group （5.43 months, P = 0.02）. The relative dose intensity was lower in serious comorbidity group [（68.4±19.9）%, P = 0.038]. Conclusion Our results suggest that mild comorbidity does not influence the response rate of first line chemotherapy in elder patients. Treatment should be used under serious consideration in elder patients with severe comorbidities.

关 键 词：化疗 老年 合并症 

分 类 号：R730.5[医药卫生—肿瘤]