晚期非小细胞肺癌NP方案化疗相关性白细胞减少与化疗疗效关系

Chemotherapy-induced Leucopenia and Treatment Outcomes of NP Regimen in Patients with Advanced Non-small Cell Lung Cancer

目的:评价NP方案化疗的晚期NSCLC患者CIL与化疗疗效之间的关系。方法:对128例Ⅰ～Ⅳ期NSCLC患者采用NP化疗方案:顺铂35mg/m2,静脉滴注,第1,2天;长春瑞滨25mg/m2,静脉滴注,第1,8天,每21天为1周期。根据CIL程度进行分组:无CIL的患者为A组;轻度CIL(GⅠ～Ⅱ)为B组;重度CIL(GⅢ～Ⅳ)为C组。主要研究目的为有效率(RR)、疾病控制率(DCR)和疾病进展时间(TTP)。结果:共有128例患者入组。A、B、C三组RR率分别为30.8%,56.8%和71.4%,P=0.010,出现CIL的患者RR率明显增高。DCR率分别为61.5%,83.8%和92.9%,P=0.009,CIL患者DCR率也明显提高。中位TTP分别为150天(95%CI:91～209),189天(95%CI:181～197)和207天(95%CI:172～242),P=0.009,CIL患者TTP明显延长。CIL持续至少10天的患者TTP延长明显,P=0.0213。轻度CIL伴ECOG0的患者TTP也明显延长,P=0.0412。结论:CIL与NP方案化疗的晚期NSCLC患者的RR和TTP有关,随CIL的出现患者RR率提高,TTP延长,尤其是轻度CIL伴ECOG0和CIL持续10天以上的患者。因此,CIL可以作为反映药物活性和预测化疗疗效的指标。

To evaluate the chemotherapy-induced leucopenia （CIL） and treatment outcomes of NP regimen in patients with advanced non-small cell lung cancer（NSCLC）. Methods： The chemotherapy consisted of Cisplatin 35mg/m^2（Ⅳ, on the first two days） and Vinorelbine 25mg/m^2（Ⅳ, on the first and eighth day）. Each cycle consisted of 21 days. The patients were classified into three groups： Group A consisted of the patients who had grade 0 leucopenia, gronp B consisted of the patients who had grade I-Ⅱ leucopenia, and group C consisted of the patients who had grade Ⅲ-Ⅳ leucopenia. Indices including response rate（RR）, disease control rate（DCR）, and time to progression（TTP） were analyzed. Results： A total of 128 patients were enrolled. The RR in group A, B and C was 30.8%, 56.8% and 71.4%, respectively （P=0.010）. The DCR in group A, B and C was 61.5%, 83.8% and 92.9%, respectively （P=0.009）. The median TTP in group A, B and C was 150 days（95% CI： 91-209）, 189 days（95% CI： 181-197） and 207 days（95% CI： 172-242）, respectively（P=0.009）. In those patients who had CIL for at least 10 days, the TTP was longer（P=-0.0213）. Patients with grade I-Ⅱ leucopenia and ECOG 0 had longer TTP （P=0.0412）. Conclusion： The occurrence of CIL is correlated with RR and TI＇P in patients with advanced NSCLC treated with Cisplatin and Vinorelbine. CIL can be a biological measure of drug activity and an index for efficacy.