多西他赛或培美曲塞一线治疗老年晚期肺腺癌的疗效及预后因素分析

Efficacy and Prognostic Factors of Docetaxel or Pemetrexed as First-line Treatment for Elderly Patients with Advanced Lung Adenocarcinoma

目的探讨多西他赛或培美曲塞单药一线治疗老年晚期肺腺癌的疗效、不良反应及预后因素。方法回顾性分析我科2008年9月至2012年3月收治的89例老年晚期肺腺癌患者的临床资料,其中多西他赛单药一线化疗组42例,治疗方案:多西他赛75 mg/m2,静脉滴注d1;培美曲塞单药一线化疗组47例,治疗方案:培美曲塞500 mg/m2,静脉滴注d1。以上方案均为21天1周期,所有患者至少接受2周期化疗。结果多西他赛组和培美曲塞组的有效率(RR)、疾病控制率(DCR)、疾病进展时间(TTP)、中位生存期(MST)、1年生存率分别为19.0%和25.5%、61.9%和63.8%、3.0月和3.6、8.5和9月、31.0%和38.3%,两组RR、DCR、TTP、MST、1年生存率间差异均无统计学意义(P>0.05)。培美曲塞组贫血、粒细胞下降、恶心呕吐、腹泻、脱发、疲劳乏力等不良反应低于多西他赛组(P<0.05)。ECOG评分、肿瘤分期、TTP和有效率是影响老年患者生存的独立预后因素(P<0.05),而性别、年龄、吸烟状态均与患者的预后无关(P>0.05)。结论多西他赛与培美曲塞单药一线治疗老年晚期肺腺癌的疗效相近,但培美曲塞单药组的不良反应明显低于多西他赛组。

Objective To evaluate the clinical efficacy, toxicity and prognostic factors of docetaxel or pemetrexed alone as the first-line treatment for elderly patients with advanced lung adenocarcinoma. Methods Retrospective analysis was adopted to evaluate 89 elderly patients with advanced lung adenocarcinoma(≥65 years) who were hospitalized in the Department of Oncology, Guangzhou General Hospital of Guangzhou Military Command, from September 2008 to March 2012. Among them, 42 patients were treated with docetaxel(75 mg/m2, iv, d1) and 47 patients were treated with pemetrexed(500 mg/m2, iv d1). Three weeks were considered as one session for both of treatments and each of them should be repeated at least twice. Results The response rate(RR), disease control rate(DCR), time to progress(TTP), median survival time(MST) and 1 year survival rate of docetaxel and pemetrexed treatments were 19.0% and 25.5%, 61.9% and 63.8%, 3.0 months and 3.6 months, 8.5 months and 9 months, 31.0% and 38.3%, respectively. There was no significant difference in RR, DCR, TTP, and MST as well as one year survival rate between two treatments(P>0.05). Notably, the side effects including anemia, leukocytopenia,nausea,vomiting,diarrhea,psilosis and fatigue in the pemetrexed group were significantly lower than those in the docetaxel group(P<0.05). Moreover, Cox multivariate regression analysis showed that TTP, ECOG,neoplasm staging and RR were independent factors for the survival rate(P<0.05). On the other hand, the factors such as gender, age and smoking status were not related to the prognosis of survival rate of patients(P>0.05). Conclusion The efficacy was identical between docetaxel and the pemetrexed regimen, but toxicity of latter was much lower than that of the former.