基于真实世界数据对晚期非小细胞肺癌合并慢性阻塞性肺疾病患者治疗模式的探讨  

Exploration of the treatment model for patients with advanced non-small cell lung cancer complicated with chronic obstructive pulmonary disease based on real-world data

作　　者：王飞[1] 谢晓鸿[1] 林心情[1] 秦茵茵[1] 谢展鸿[1] 张洁霞[1] 欧阳铭[1] 周承志[1] Wang Fei;Xie Xiaohong;Lin Xinqing;Qin Yinyin;Xie Zhanhong;Zhang Jiexia;Ouyang Ming;Zhou Chengzhi(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China)

机构地区：[1]广州医科大学附属第一医院呼吸与危重症医学科,510120

出　　处：《中华结核和呼吸杂志》2020年第5期450-454,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：广东省高水平大学临床培育项目(2018-2022);广州医科大学呼吸疾病国家重点实验室自主课题(SKIRD-QN-201720);广州医科大学呼吸疾病国家重点实验室开放课题(SKIRD-OP-20180110)。

摘　　要：目的基于真实世界数据对晚期非小细胞肺癌(NSCLC)合并慢性阻塞性肺疾病(慢阻肺)患者治疗模式进行研究,探讨两种疾病同时治疗疗效是否优于单纯治疗肿瘤。方法回顾性分析2015年1月1日至2017年12月31日入住我院的101例NSCLC合并慢阻肺的患者,其中男99例,女性2例,年龄52~84岁,平均(67±8)岁,吸烟患者90例,均为男性,平均吸烟指数为(47±4)包年。根据患者是否在抗肿瘤治疗的基础上规律治疗慢阻肺分为观察组和对照组,治疗组(两种疾病同时治疗)患者36例,男性35例,女性1例,年龄54~84岁,平均(67±8)岁,平均吸烟指数为(47±4)包年;对照组(仅治疗肺癌)患者65例,男性64例,女性1例,年龄52~83岁,平均(67±8)岁,平均吸烟指数为(47±4)包年,两组患者基线资料比较差异无统计学意义。主要观察指标为两组患者的客观缓解(objective response rate,ORR)、疾病控制率(disease control rate,DCR)、无疾病进展时间(progression-free surival,PFS)及总生存期(overall survival,OS)。计数资料比较采用χ2检验;计量资料比较采用独立样本t检验,生存曲线采用Kaplan-Meier法绘制,生存率比较采用log-rank检验。结果观察组和对照组患者的ORR分别为22.6%(7例)和22.2%(11例),差异无统计学意义(χ^2=0.01,P=0.971);DCR分别为58.1%(19例)和57.8%(27例),差异无统计学意义(χ^2=0.02,P=0.885)。观察组患者中位PFS为6.0个月,优于对照组的3.5个月,差异有统计学意义(χ^2=3.947,P<0.05);观察组患者中位OS为18.0个月,优于对照组的15.0个月,差异有统计学意义(χ^2=4.083,P<0.05)。结论与单纯治疗肿瘤相比,晚期NSCLC合并慢阻肺患者在抗肿瘤治疗的基础上规律治疗慢阻肺患者的PFS及OS更长。Objective To explore whether combining treatment of chronic obstructive pulmonary disease(COPD)with anti-tumor therapy is better than that of tumor treatment alone in advanced non-small cell lung cancer(NSCLC)patients with COPD in the real world.Methods The clinical data of 101 patients with advanced NSCLC complicated with COPD from January 1,2015,to December 31,2017,in the First Affiliated Hospital of Guangzhou Medical University were analyzed retrospectively,including 99 males and two females,aged from 52 to 84 years[average(67±8)years].Among the patients,90(89.1%)were smokers,with an average pack-year smoking index of(47±4).The patients were divided into observation and control groups,depending on whether they received standardized anti-COPD supportive treatment.In the observation group,there were 36 patients,including 35 males and one female,aged from 54 to 84 years[average(67±8)years],with an average pack-year of smoking(47±4).There were 65 patients in the control group,including 64 males and one female,aged from 52 to 83 years[average(67±8)years],with an average pack-year of smoking 47±4.There was no significant difference in the baseline data between the two groups.The primary outcome measures included the Objective response rate(ORR),disease control rate(DCR),disease-free survival(PFS),and overall survival(OS)of the two groups.An unpaired t-test was used to compare continuous variables between the observation and control groups.The Pearson chi-square test was used to compare categorical variables between the two groups.Kaplan-Meier survival curves were used to evaluate the median PFS and median OS of patients,and the log-rank test was used to assess differences between groups.Result The ORR of the observation group and the control group was 22.6%(7 cases)and 22.2%(11 cases),respectively,with no significant difference(χ^2=0.01,P=0.971).The DCR between the observation group and the control group was 58.1%(19 cases)and 57.8%(27 cases),with no significant difference(χ^2=0.02,P=0.889).Median PFS in the

关 键 词：癌 非小细胞肺 肺疾病 慢性阻塞性 

分 类 号：R563[医药卫生—呼吸系统] R734[医药卫生—内科学]