经体动脉灌注化疗后手术治疗不可切除Ⅲ期非小细胞肺癌的疗效  

Transcatheter arterial infusion chemotherapy followed by surgery in patients with unresectable stage Ⅲ non-small cell lung cancer

作　　者：罗洁 韩超楠[2] 陈斌 虞栋[3] 江森[3] LUO Jie;HAN Chaonan;CHEN Bin;YU Dong;JIANG Sen(Department of Oncology, Third Affiliated Hospital of Soochow University, Changzhou 213003, Jiangsu Province, China;Department of Oncology, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China;Department of Radiology, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China)

机构地区：[1]苏州大学附属第三医院肿瘤科,江苏常州213003 [2]同济大学附属上海市肺科医院肿瘤科,上海200433 [3]同济大学附属上海市肺科医院放射科,上海200433

出　　处：《肿瘤》2018年第6期590-598,共9页Tumor

摘　　要：目的:本研究旨在探讨经导管动脉灌注(transcatheter arterial infusion,TAI)化疗后手术治疗不可切除Ⅲ期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者的疗效和不良反应。方法:对符合病例入组标准的81例不可切除Ⅲ期NSCLC患者的病历资料进行回顾性分析。所有患者均接受2个疗程的TAI化疗,对达到部分缓解或肿瘤缩小的疾病稳定患者行手术治疗。主要研究终点为总生存(overall survival,OS),次要研究终点为疾病控制率(disease control rate,DCR)和安全性。结果:2个疗程TAI化疗后疗效评价结果:部分缓解40例(49.4%),疾病稳定30例(37.0%),疾病进展11例(13.6%);DCR为86.4%(70/81)。主要不良反应均为Ⅰ～Ⅱ度。在55例于TAI化疗后接受手术治疗的患者中,手术切除率为94.5%(52/55),术后并发症发生率为32.7%(18/55);术后1年、2年和3年生存率分别为78.2%、52.7%和34.5%。亚组分析结果表明,部分缓解患者的OS明显优于疾病稳定患者,中位生存期分别为37.0和21.0个月(P=0.019);术前诊断为鳞癌的患者的中位生存期(34.0个月)较腺癌患者(13.5个月)有所延长,但差异无统计学意义(P=0.101)。多因素分析结果显示,近期疗效是预后的独立影响因素,部分缓解患者的预后优于疾病稳定患者(风险比为0.467,95%可信区间:0.238～0.916;P=0.027)。结论:对于不可切除的Ⅲ期NSCLC患者,TAI化疗是一种有效而安全的新辅助治疗模式,尤其是对于取得部分缓解或术前诊断为鳞癌的患者,术后的生存获益更为显著。Objective： To evaluate the clinical response, adverse reactions and prognosis of transcatheter arterial infusion （TAI） chemotherapy followed by surgery in patients with unresectable stage Ⅲ non-small cell lung cancer （NSCLC）.Methods： A retrospective study was performed in 81 patients with unresectable stage Ⅲ NSCLC. All patients received 2 cycles of TAI chemotherapy. Surgical treatment was performed for patients with partial response or patients with stable disease and tumor reduction. The primary endpoint was overall survival （OS） and the secondary endpoints were disease control rate （DCR） and adverse reactions.Results： The results of response evaluation after 2 cycles of TAI chemotherapy were partial response in 40 patients （49.4%）, stable disease in 30 patients （37.0%） and disease progression in 11 patients （13.6%）; the DCR was 86.4% （70/81）. The main adverse reactions were graded as Ⅰ-Ⅱ. In 55 patients undergoing TAI chemotherapy, the surgical resection rate was 94.5% （52/55）, and the postoperative complication rate was 32.7% （18/55）; the 1-, 2- and 3-year survival rates were 78.2%, 52.7% and 34.5%, respectively. The subgroup analysis showed that the OS of the patients with partial response was significantly better than that of the patients with stable disease; the median survival time were 37.0 and 21.0 months, respectively （P = 0.019）. The median survival time （34.0 months） of the patients diagnosed of squamous cell carcinoma was longer than that of the patients diagnosed of adenocarcinoma （13.5 months）, but the difference was not statistically significant （P = 0.101）. The results of multivariate analysis showed that the short-term response was an independent prognostic factor, and the prognosis of patients achieving partial response was better than that of the patients achieving stable disease （the hazard ratio was 0.467, the 95% confidence interval was 0.238 to 0.916; P = 0.027）.Conclusion： For patients with unresectable stage Ⅲ

关 键 词：癌 非小细胞肺 新辅助化疗 经导管动脉灌注 预后 

分 类 号：R734.2[医药卫生—肿瘤]