二线化疗方案治疗小细胞肺癌的疗效及预后分析  

Efficacy and prognostic factors analysis on small-cell lung cancer patients with second-line chemotherapy

作　　者：李治桦 李朝霞 陈俊男 查皓然 申文楠 董月美 赵玮 王宁 刘晓晴 LI Zhihua;LI Zhaoxia;CHEN Junnan;ZHA Haoran;SHEN Wennan;DONG Yuemei;ZHAO Wei;WANG Ning;LIU Xiaoqing(Department of Oncology,Characteristic Medical Center of the Rocket Force of PLA,Beijing 100088,China;Department of Medical Oncology,the Fifth Medical Center of PLA General Hospital,Beijing 100071,China.)

机构地区：[1]解放军火箭军特色医学中心肿瘤科,北京100088 [2]解放军总医院第五医学中心肿瘤医学部,北京100071

出　　处：《现代肿瘤医学》2024年第15期2760-2766,共7页Journal of Modern Oncology

基　　金：国家自然科学基金青年项目(编号:31900627)。

摘　　要：目的:分析小细胞肺癌(small-cell lung cancer, SCLC)患者二线化疗的近期疗效和生存的预后因素,为临床治疗此类患者提供一定的依据。方法:回顾性地分析2010年01月至2014年12月接受二线化疗的152例SCLC患者的临床资料及随访结果。生存期采用Kaplan-Meier法模拟,生存期影响因素分析采用单因素分析和Cox比例风险模型分析。结果:入组SCLC患者二线化疗客观缓解率(objective response rate, ORR)为39.5%,中位无进展生存时间(progression-free survival, PFS)为3.1个月,中位总生存时间(overall survival, OS)为5.3个月;二线化疗的近期疗效与一线化疗的近期疗效相关(P<0.001);敏感型患者较耐药/难治型患者能够获得更好的二线化疗治疗反应(P=0.003);敏感型组、耐药型组和难治型组二线化疗的中位OS分别为5.5、5.3和4.7个月,差异无统计学意义(P=0.071);影响二线PFS的独立预后因素为诊断时和二线化疗前的ECOG PS评分(P=0.001/0.001)、肝转移(P=0.001)、骨转移(P=0.007);影响二线OS的预后因素为诊断时及二线化疗前的ECOG PS评分(P=0.023/0.003)、肝转移(P=0.001)。结论:一线化疗疗效较好的患者能在二线化疗后得到更好的治疗反应和生存获益,患者诊断时和二线治疗前的ECOG PS评分、肝转移为二线化疗重要的生存预后因素。Objective:To analyze the influence factors of the efficacy and survival outcomes of small-cell lung cancer(SCLC)patients received second-line chemotherapy,to provide some evidence for treating such patients in clinical practice.Methods:The clinical data and follow-up results of 152 SCLC patients received second-line chemotherapy from January 2010 to December 2014 were retrospectively analyzed.The Kaplan-Meier method survival curves were used to analysis survival benefit,and univariate analyse and Cox proportional hazards model were used to analyse prognostic factors of survival outcomes of the patients.Results:The objective response rate(ORR)of the SCLC patients who received second-line chemotherapy was 39.5%.The median progression-free survival(PFS)and overall survival(OS)from second-line chemotherapy were 3.1 months and 5.3 months.Curative effect of second-line chemotherapy was correlated with that of first-line chemotherapy(P<0.001).The therapeutic response of second-line chemotherapy in the sensitive disease patients was better than that in the resistance or the refractory disease patients(P=0.003),and the median OS from second-line chemotherapy of the three groups patients were 5.5 months,5.3 months and 4.7 months,and with no statistic differences( P =0.071).The ECOG PS score at diagnosis and before second-line chemotherapy( P =0.001/0.001),as well as liver metastasis( P =0.001) and bone metastasis( P =0.007),were independent risk factors for PFS from second-line chemotherapy.The ECOG PS score before second-line chemotherapy( P =0.023/0.003) and liver metastasis( P =0.001) were independent risk factors for OS from second-line chemotherapy. Conclusion: The SCLC patients who obtained better efficacy in the first-line chemotherapy may gain better therapeutic response and survival benefit after second-line chemotherapy.The ECOG PS score at diagnosis and before second-line chemotherapy and liver metastasis were significant prognostic factors for the second-line chemotherapy.

关 键 词：小细胞肺癌 二线化疗 缓解率 生存 影响因素 

分 类 号：R734.2[医药卫生—肿瘤]