吉西他滨联合顺铂与去甲长春碱联合顺铂治疗老年晚期非小细胞肺癌临床分析

Gemcitabine plus cisplatin vs navelbine plus cisplatin in treatment of elderly patients with advanced non small cell lung cancer

目的观察比较吉西他滨联合顺铂(GP方案)与去甲长春碱联合顺铂(NP方案)治疗老年晚期非小细胞肺癌的疗效、生存期及毒副反应。方法对61例经病理或细胞学证实的晚期非小细胞肺癌老年患者(年龄>70岁)随机分为两组,GP方案组30例,NP方案组31例。GP组吉西他滨1000mgm2,静脉滴注,第1,8天;顺铂80～100mgm2,静脉滴注,第1天。NP组去甲长春碱25mgm2,静脉滴注,第1,8天;顺铂用法及剂量同GP组。两组均21d为一周期,每例患者治疗两周期以上。结果GP组总有效率40.0%,1年生存率为34.8%,中位生存期9.3个月;NP组总有效率38.7%,1年生存率30.0%,中位生存期为8.8个月。两组间总有效率、1年生存率比较差异均无显著性(P=0.58,P=0.51)。最常见的毒副反应为骨髓抑制,GP组Ⅲ～Ⅳ度血小板减少发生率显著高于NP组(P=0.016),而NP组Ⅲ～Ⅳ度白细胞减少发生率显著高于GP组(P=0.01)。结论吉西他滨联合顺铂与去甲长春碱联合顺铂治疗老年晚期非小细胞肺癌疗效肯定,毒性均可耐受。两方案疗效差异无显著性。

Objective To evaluate and compare the therapeutic efficacy and toxicity between combination of gemcitabine and cisplatin (GP) and combination of navelbine and cisplatin (NP) in elderly patients with advanced non small cell lung cancer(NSCLC).Methods Sixty one patients with local advanced or metastatic NSCLC were enrolled into the study,with 30 patients in GP group and 31patients in NP group. Patients' characteristics were similar between the two groups.They were given gemcitabine 1000 mg/m 2 or navelbine 25 mg/m 2 on days 1 and 8,and cisplatin 80 100 mg/m 2 on day 1.The chemotherapy was repeated every 3 weeks as a cycle.Results Objective response rate of 40.0% was observed in GP group versus 38.7% in NP group( P =0.58).The 1 year survival rate was 34.8% in GP group and 30.0% in NP group( P =0.51). The median survival duration was 9.3 months in GP group and 8.8 months in NP group. Myelosuppression was the major dose-limiting toxicity. The incidence of gradeⅢ/Ⅳ leukopenia was significantly higher in the NP group than in the GP group( P = 0.01 ),while gradeⅢ/Ⅳ thrombocytopenia occurred more frequently in the GP group than in NP group( P = 0.016 ).Conclusion The GP combination is as equally active and well tolerated as the NP combination in elderly patients with advanced non-small cell lung cancer.