序贯与同步放化疗治疗老年局部晚期非小细胞肺癌的疗效及影响因素分析  

Efficacy and influencing factors of sequential and concurrent chemoradiotherapy in the treatment of advanced non-small cell lung cancer in elderly patients

作　　者：王子红 陈文彰[1] 孙保锦 Wang Zihong;Chen Wenzhang;Sun Baojin(Department of Oncology,Beijing Shijingshan Hospital,Beijing 100043,China)

机构地区：[1]北京市石景山医院肿瘤科,北京100043 [2]北京市世纪坛医院放疗科,北京100043

出　　处：《中国医师进修杂志》2023年第2期119-123,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的:比较序贯放化疗与同步放化疗治疗老年局部晚期非小细胞肺癌(NSCLC)的疗效,并分析预后影响因素。方法:回顾性分析2015年3月至2018年3月北京市石景山医院和北京市世纪坛医院收治的195例老年局部晚期NSCLC患者,按照放化疗方案不同分为同步放化疗组(100例)和序贯放化疗组(95例),比较两组近期疗效、3年生存情况、预后影响因素及不良反应。结果:同步放化疗组客观有效率高于序贯放化疗组[61.00%(61/100)比44.21%(42/95)],差异有统计学意义(χ^(2)=5.51,P<0.05)。同步放化疗组2、3年生存率分别为52.00%、23.00%,高于序贯放化疗组的32.60%、11.60%,差异均有统计学意义(χ^(2)=5.87、5.42,P<0.05)。多因素Cox回归分析结果显示,吸烟、Karnofsky评分<70分、TNM分期Ⅲb期、近期疗效/(疾病稳定+疾病进展)、治疗方法/序贯放化疗是老年局部晚期NSCLC患者预后的独立危险因素(P<0.05)。同步放化疗组放射性食管炎、骨髓抑制、肺功能损害发生率高于序贯放化疗组[45.00%(45/100)比27.37%(26/95)、36.00%(36/100)比22.11%(21/95)、48.00%(48/100)比26.32%(25/95)],差异有统计学意义(χ^(2)=6.54、4.55、9.78,P<0.05)。结论:同步放化疗能够提高老年局部晚期NSCLC患者近期疗效,改善患者2、3年生存率,但不良反应明显增强。Objective To explore the efficacy of sequential and concurrent chemoradiotherapy in the treatment of advanced non-small cell lung cancer(NSCLC)in the elderly,and to analyze the influencing factors of prognosis and outcome.Methods The clinical data of 195 elderly patients with advanced NSCLC admitted to Beijing Shijingshan Hospitaland and Beijing Shijitan Hospital from March 2015 to March 2018 were retrospectively analyzed.They were divided into the concurrent chemoradiotherapy(100 cases)and the sequential chemoradiotherapy(95 cases)according to different chemoradiotherapy regiments.The short-term efficacy,3-year survival,influencing factors of prognosis and toxic and adverse effects of the two groups were compared.Results The objective response rate in the concurrent chemoradiotherapy group was significantly higher than that in the sequential chemoradiotherapy group:61.00%(61/100)vs.44.21%(42/95),there was statistically difference(χ^(2)=5.51,P<0.05).The 2-year and 3-year survival rate in the concurrent chemoradiotherapy group were 52.00%and 23.00%,which were significantly higher than those in the sequential chemoradiotherapy group:32.60%,11.60%,there were statistically differences(P<0.05).Multivariate analysis results showed that smoking,Karnofsky score<70,TNM stageⅢb,short-term efficacy and treatment methods/sequential chemoradiotherapy were independent risk factors(P<0.05).The incidence of radiation esophagitis,bone marrow suppression and lung function damage in the concurrent chemoradiotherapy group were higher than those in the sequential chemoradiotherapy group:45.00%(45/100)vs.27.37%(26/95),36.00%(36/100)vs.22.11%(21/95),48.00%(48/100)vs.26.32%(25/95),there were statistically differences(χ^(2)=6.54,4.55,9.78;P<0.05).Conclusions Concurrent chemoradiotherapy can improve the short-term efficacy,and improve the 2-year and 3-year survival rates in advanced NSCLC in elderly patients,but the adverse effects are significantly enhanced.

关 键 词：癌 非小细胞肺 不良反应 序贯治疗 同步治疗 

分 类 号：R734.2[医药卫生—肿瘤]