培美曲塞／多西他赛二线化疗晚期非小细胞肺癌预后因素分析  

Analysis of prognostic factors for the outcome of second-line therapy with pemetrexed or docetaxel in patients with advanced non-small-cell lung cancer

作　　者：刘洁[1] 王秀问[1] Liu Jie;Wang Xiuwen(Department of Chemotherapy,Qilu Hospital,Shandong University,Ji＇nan 250000,China)

机构地区：[1]山东大学齐鲁医院化疗科,济南250000

出　　处：《中国医师进修杂志》2018年第8期717-723,共7页Chinese Journal of Postgraduates of Medicine

摘　　要：目的大量的研究发现采用培美曲塞与多西他赛对晚期非小细胞肺癌患者的治疗疗效无显著差异。回顾性分析了培美曲塞/多西他赛的二线治疗晚期非小细胞肺癌试验中的预后因素情况，同时分析了一线治疗方案对于二线化疗的影响。方法对2012年3月至2017年3月经过病理组织学或细胞学证实的134例晚期肺癌患者一线化疗无效进行培美曲塞或多西他赛二线治疗，其中培美曲塞500 mg/m2，静脉滴注时间〉10 min，每21天为一个疗程；多西他赛75 mg/m2，静脉滴注时间〉30 min，每21天为一个疗程。根据一线化疗方案将患者分为三组，分别为顺铂＋吉西他滨化疗方案组（50例），顺铂＋紫杉醇化疗方案组（38例）和其他化疗方案组（46例）。采用单变量分析方法及多因素回归分析方法分析患者的年龄、性别、患者肿瘤分期、二线治疗初始功能评分、一线治疗疗效反应、一线治疗至二线治疗的时间间隔与患者总生存期之间的关联性。同时分析一线治疗方案对二线治疗患者总生存期的影响。结果通过多因素回归分析发现培美曲塞/多西他赛二线治疗晚期非小细胞肺癌的总生存期与患者性别、患者肿瘤分期、二线治疗初始功能评分、一线治疗疗效反应这四个因素具有显著关联性。其中，女性患者中位生存期与男性患者中位生存期比较（9.2个月比6.8个月）差异有统计学意义（P〈0.05）。肿瘤分期Ⅲ期生存期与Ⅳ期生存期比较（9.3个月比7.4个月）差异有统计学意义（P〈0.05）。初始功能评分0、1及2分的中位生存期分别为12.1、7.8和2.9个月，三者比较差异有统计学意义（P〈0.01）。一线疗效反应部分/完全缓解中位生存期为15.4个月，病情稳定中位生存期10.7个月，疾病进展中位生存期为4.3个月，三者比较差异有统计学意义（P〈0.01）。一线治疗顺铂＋吉西他滨化疗方案�ObjectiveA large phase Ⅲ comparison trial of pemetrexed to docetaxel showed similar efficacy for treating advanced non-small-cell lung cancer. In this paper, the prognostic factors for the outcome of second-line therapy with pemetrexed or docetaxel in patients with advanced non-small-cell lung cancer were retrospective analyzed. At the same time, the impact of first-line chemotherapy on the outcome of second-line chemotherapy was analyzed.MethodsFor 134 patients with advanced NSCLC were randomly assigned to receive pemetrexed 500 mg/m2 or docetaxel 75 mg/m2 on day 1 of a 21-day cycle. According to the type of first-line therapy, patients were divided into three groups： platinum combined with gemcitabine group （50 cases）, platinum combined with taxane group （38 cases） and other therapies group （46 cases）. Univariate and multivariate analysis methods were used to compute the relationship between prognostic factors, including age, gender, stage at diagnosis, performance status, best response to first-line therapy and time elapsed from first- to second-line therapy, and patients′ overall survival.ResultsThrough multivariate analysis we found patients′ gender, stage at diagnosis, performance status and best response to first-line therapy was significant correlatedion with overall survival. Among them, median survival time for female and male patients was 9.2 and 6.8 months respectively with a significant difference between them （P〈0.05）. In addition, median survival time for stage Ⅲ and Ⅳ was 9.3 and 7.4 months respectively with a significant difference （P〈0.05）. At the same time, median survival time for ECOG PS 0, 1 and 2 was 12.1, 7.8 and 2.9 months with a significant difference （P〈0.01）. For complete/partial remission patients, stable condition patients, disease progression patients after first-line therapy, the median survival time was 15.4, 10.7 and 4.3 months respectively with a significant difference （P〈0.01）. Additional, median survival time for first-line thera

关 键 词：癌 非小细胞肺 培美曲塞 多西他赛 生存分析 

分 类 号：R734.2[医药卫生—肿瘤]