唑来膦酸联合^(89)Sr治疗无症状非小细胞肺癌骨转移临床研究  

Clinical research of zoledronic acid and strontium-89in treatment of patients with asymptomatic bone metastases from non-small cell lung cancer

作　　者：李宁[1] 杨志[1] 柴华[1] 姚忠强[1] 杨鸿宇[1] 廖光星 李党生[1] 肖国有[1] LI Ning;YANG Zhi;CHAI Hua;YAO Zhong-qiang;YANG Hong-yu;LIAO Guang-xing;LI Dang-sheng;XIAO Guo-you(Department of Nuclear Medicine,Affiliated Tumor Hospital of Guangxi Medical University,Nanning 530021,P.R.China)

机构地区：[1]广西医科大学附属肿瘤医院核医学科,广西南宁530021

出　　处：《中华肿瘤防治杂志》2018年第13期962-967,共6页Chinese Journal of Cancer Prevention and Treatment

基　　金：广西医疗卫生适宜技术开发与推广应用项目(S201633);广西教育厅2016年中青年教师基础能力提升项目(KY2016LX-025);2016年度广西高等教育本科教学改革工程立项项目(2016JGB186)

摘　　要：目的晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者常发生骨转移,本研究旨在评价唑来膦酸联合^(89)Sr或二者单独治疗无症状NSCLC骨转移的临床价值。方法选取广西医科大学附属肿瘤医院核医学科2014-01-01-2016-12-31收治的非小细胞肺癌骨转移患者105例,均经病理确诊,影像学检查明确有骨转移,按简单随机方法分为3组,唑来膦酸联合^(89)Sr治疗组(A组)35例,平均年龄(57±19)岁;单独给予^(89)Sr治疗组(B组)35例,平均年龄(58±13)岁;单独给予唑来膦酸治疗组(C组)35例,平均年龄(58±15)岁,其中,B与C组为对照组。首次骨相关事件(skeletal-related events,SREs)发生时间和总生存采用Kaplan-Meier方法分析,组间比较采用Log-rank检验,多因素分析采用Cox比例风险回归模型。治疗12个月后分析比较组间SREs累积发病率。结果 3组的基线特征相似。A组至首次SREs中位时间为14个月(95%CI为11.8~16.2个月),B和C组分别为9(95%CI为7.6~10.4个月)和11个月(95%CI为9.4~12.6个月)。A与B组比较差异有统计学意义,χ~2=26.295,P<0.05;与C组比较差异也有统计学意义,χ~2=6.034,P<0.05。A组的总生存时间为16个月(95%CI为14.9~17.1个月),B和C组分别为11(95%CI为9.9~12.1个月)和12个月(95%CI为10.6~13.4个月)。A与B组比较差异有统计学意义,χ~2=11.832,P<0.05;与C组比较差异也有统计学意义,χ~2=5.610,P<0.05。Cox多因素分析显示,T(P=0.004)、N(P=0.033)、M(P=0.041)高分期与多发骨转移病灶数(P=0.048)是影响患者首次SREs发生时间和总体生存期的独立危险因素。A组治疗12个月后SREs累积发病率为37.1%(13/35),B和C组分别为80.0%(28/35)和54.3%(19/35)。A与B组比较差异有统计学意义,χ~2=11.433,P<0.05;与C组比较差异无统计学意义,χ~2=2.072,P>0.05。结论唑来膦酸联合^(89)Sr使用与二者单独使用相比,可显著延迟NSCLC骨转移患者首次SREs发生时间,延长生存期及降低SREs累积发病率,TNM分期与骨转移病�OBJECTIVE To evaluate the clinical value in patients of non-small cell lung cancer（NSCLC）with asymptomatic bone metastases treated by merging zoledronic acid（ZA）and stronium-89（Sr-89）.The results were compared with those who received ZA or Sr-89 separately.METHODS On the basis of pathology and imageological diagnosis,105 patients suffered from asymptomatic bone metastases of NSCLC between January 2014 and December 2016 were recruited and randomly divided into three groups：group A was treated with ZA and Sr-89 simultaneously,group B was treated with Sr-89,group C was treated with ZA,group B and C constituted the control groups.Time to the first skeletal-related events（SREs）and overall survival（OS）were calculated with the Kaplan-Meier method and compared by the Log-rank test.The main risk factors were screened by Cox hazard regression model.The other efficacy analysis was the percentage of patients with SREs at 12 months,which was compared between treatment groups using the contingency tables.RESULTS It was found that the baseline characteristics of three groups were similar.The time to first SREs were 14（95%CI：11.8-16.2）,9（95%CI：7.6-10.4）and 11（95%CI：9.4-12.6）months for group A,B and C,respectively.There was statistical significant for the difference between group A and control groups（χ^2 values were 26.295 and 6.034,respectively,all P〈0.05）.The OS were 16（95%CI：14.9-17.1）,11（95%CI：9.9-12.1）and 12（95%CI：10.6-13.4）months for group A,B and C,respectively.There were statistical significant for the differences between group A and control groups（χ^2 values were 11.832 and 5.610,respectively（both P〈0.05）.Multivariate analysis by the Cox proportional hazards model was showed that T（P=0.004）,N（P=0.033）,M（P=0.041）stages and number of lesions（P=0.048）were the independent risk factors for the NSCLC outcome.The annual incidence of SREs was 37.1%（13/35）for group A,80.0%（28/35）for group B,54.3%（19/35）for group C,respectively.Th

关 键 词：非小细胞肺癌 骨转移 骨相关事件 唑来膦酸 ^89SR 

分 类 号：R734.2[医药卫生—肿瘤]