晚期肺腺鳞癌患者不同一线化疗方案疗效观察  

Efficacy of different first-line chemotherapy regimens for advanced lung adenosquamous carcinoma

作　　者：吴仕文 郑新龙 徐贻佺 徐海鹏[1] 张龙凤 刘涛 李冰 王贻军 吴敬勋[5] 吴辉塔[6] 陈鹏涛[7] 杨红奎 林根[1] WU Shiwen;ZHENG Xinlong;XU Yiquan;XU Haipeng;ZHANG Longfeng;LIU Tao;LI Bing;WANG Yijun;WU Jingxun;WU Huita;CHEN Pengtao;YANG Hongkui;LIN Gen(Department of Thoracic Oncology,Clinical Oncology School of Fujian Medical University,Fujian Cancer Hospital,Fuzhou,Fujian 350000,China;Department of Medical Oncology,Zhangzhou Zhengxing Hospital,Zhangzhou,Fujian 363000,China;Department of Medical Oncology,the Affiliated Hospital of Putian University,Putian,Fujian 351100,China;Department of Medical Oncology,Zhangzhou Affiliated Hospital of Fujian Medical University,Zhangzhou,Fujian 363000,China;Department of Medical Oncology,the First Affiliated Hospital of Xiamen University,Xiamen,Fujian 361003,China;Department of Oncology,Zhongshan Hospital of Xiamen University,Xiamen,Fujian 361001,China;Department of Medical Oncology,Fuding City Hospital,Ningde,Fujian 355200,China;Department of Medical Oncology,the First Hospital of Quanzhou,Quanzhou,Fujian 362002,China)

机构地区：[1]福建医科大学肿瘤临床医学院,福建省肿瘤医院胸部肿瘤内科,福建福州350000 [2]漳州正兴医院肿瘤内科,福建漳州363000 [3]莆田学院附属医院肿瘤内科,福建莆田351100 [4]福建医科大学附属漳州市医院肿瘤内科,福建漳州363000 [5]厦门大学附属第一医院肿瘤内科,福建厦门361003 [6]厦门大学附属中山医院肿瘤科,福建厦门361001 [7]福鼎市医院肿瘤内科,福建宁德355200 [8]泉州市第一医院肿瘤内科,福建泉州362002

出　　处：《中华实用诊断与治疗杂志》2024年第1期86-91,共6页Journal of Chinese Practical Diagnosis and Therapy

基　　金：福建省科技创新联合资金项目(2020Y9038);福建省卫生系统创新项目(2020CXA010)

摘　　要：目的 比较晚期肺腺鳞癌患者采用培美曲塞、紫杉醇类/吉西他滨为主的一线化疗方案治疗的效果,探讨对患者生存期的影响。方法 2012年1月—2022年4月福建省肿瘤医院、漳州正兴医院、莆田学院附属医院、福建医科大学附属漳州市医院、厦门大学附属第一医院、厦门大学附属中山医院、福鼎市医院、泉州市第一医院诊治晚期肺腺鳞癌患者71例,采用培美曲塞为主的方案化疗者16例为培美曲塞组,采用紫杉醇类/吉西他滨为主的方案化疗者55例为紫杉醇类/吉西他滨组,2组化疗期间均依据基因检测结果等联合应用表皮生长因子受体络氨酸激酶抑制剂或抗血管生成治疗药物或免疫检查点抑制剂,每化疗1~2个周期评价疗效1次。比较2组性别比例、年龄、吸烟史、确诊晚期时美国东部肿瘤协作组(ECOG)评分以及脑转移、肝转移、骨转移、基因突变、程序性死亡配体1(PD-L1)表达情况和一线化疗的近期疗效。随访至2022年10月,比较2组中位无进展生存期(mPFS);比较不同性别、年龄、ECOG评分以及有无脑转移、肝转移、骨转移、基因突变者mPFS。结果 (1)培美曲塞组女性比率(56.2%)高于紫杉醇类/吉西他滨组(23.6%)(χ^(2)=6.165,P=0.017),年龄≥65岁、ECOG评分≥2分、吸烟、脑转移、肝转移、骨转移比率与紫杉醇类/吉西他滨组比较差异均无统计学意义(P>0.05)。(2)培美曲塞组7例行基因检测,均检出EGFR突变。紫杉醇类/吉西他滨组33例行基因检测,检出EGFR突变6例,EGFR突变合并c-MET扩增1例,ALK基因突变1例,HER2突变1例,KRAS突变1例,TP53突变1例,TP53突变合并BRAF突变1例。培美曲塞组1例检测PD-L1表达,为阴性;紫杉醇类/吉西他滨组7例检测PD-L1表达,3例阳性,4例阴性。(3)培美曲塞组客观缓解率、疾病控制率(43.8%、75.0%)与紫杉醇类/吉西他滨组(41.8%、76.4%)比较差异均无统计学意义(χ^(2)=0.019,P=0.556;χ^(2)=0.013,P=0.Objective To compare the therapeutic efficacy of pemetrexed versus paclitaxel/gemcitabine-based first-line chemotherapy regimen on advanced lung adenosquamous carcinoma,and to explore their influences on the survival of patients.Methods From January 2012 to April 2022,71 patients with advanced lung adenosquamous carcinoma were diagnosed and treated in Fujian Cancer Hospital,Zhangzhou Zhengxing Hospital,the Affiliated Hospital of Putian University,the Affiliated Zhangzhou Hospital of Fujian Medical University,the First Affiliated Hospital of Xiamen University,the Affiliated Zhongshan Hospital of Xiamen University,Fuding City Hospital and the First Hospital of Quanzhou,among whom 16 patients received pemetrexed chemotherapy regimen(pemetrexed group) and 55 patients received paclitaxel/gemcitabine chemotherapy regimen(paclitaxel/gemcitabine group).During chemotherapy,epidermal growth factor receptor tyrosine kinase inhibitor,antiangiogenic drugs,or immune checkpoint inhibitors were applied in combination according to gene detection results and other factors,and the efficacy was evaluated once every 1 to 2 cycles of chemotherapy.The gender ratio,age,smoking habits,Eastern Cooperative Oncology Group(ECOG) score,brain metastasis,liver metastasis,bone metastasis,gene mutation,and expression of programmed death ligand 1(PD-L1) were compared between two groups.The short-term efficacy of first-line chemotherapy was compared between two groups.The latest follow-up was conducted in October 2022,and the median progression-free survival(mPFS) was compared between two groups,and also in patients with different gender,age,ECOG score,and with and without brain metastasis,liver metastasis,bone metastasis and gene mutations.Results(1) The female ratio was higher in pemetrexed group(56.2%) than that in paclitaxel/gemcitabine group(23.6%)(χ^(2)=6.165,P=0.017).There were no significant differences in the proportions of patients with age ≥65 years,ECOG score ≥2,smoking habits,brain metastasis,liver metastasis,and bone metastasis b

关 键 词：肺腺鳞癌 非小细胞肺癌 化疗 培美曲塞 紫杉醇类 吉西他滨 

分 类 号：R734.2[医药卫生—肿瘤]