晚期非小细胞肺癌一线化疗疗效与生存关系的分析

Analysis of the relationship between the response after the First-line chemotherapy and the survival in the advanced non-small cell lung cancer

背景与目的第三代新药组成的方案在晚期NSCLC一线化疗中使大部分患者能够取得疾病控制(CR+PR+SD),我们进行了本项回顾性分析以探讨一线化疗疾病控制与疾病未控(PD)患者之间生存的差别,以及疾病控制患者有效(CR+PR)和稳定(SD)患者之间生存的差别,明确与患者生存有关的预后因素。方法本项回顾性分析纳入了完成第三代新药组成的铂类或非铂类方案一线化疗的118例IIIB期(伴恶性胸水)/IV期NSCLC患者,一线化疗的疗效按RECIST标准根据影像学结果评价为CR,PR,SD,PD四种情况。结果一线化疗后CR+PR+SD共86例(72.9%)[其中CR2例(1.7%),PR47例(39.8%),SD37例(31.4%)],PD32例(27.1%)。CR+PR+SD和PD患者MST有统计学差别,为17.8月和8.4月(P=0.001)。CR+PR和SD患者MST无统计学差别,为18.1月和15.5月(P=0.917),中位PFS无统计学差别,为7.1月和6.9月(P=0.622)。Cox多因素回归分析显示分期(IIIB期或IV期)、化疗线程(≤3线或≥4线)、一线化疗疾病是否控制是总生存的独立预后因素。结论本研究结果表明,晚期NSCLC患者一线化疗有效和稳定的患者其生存较进展患者好,疾病稳定患者的生存获益与有效患者无明显差别。

Background and objective Most patients with advanced non-small cell lung cancer （NSCLC） treated with first-line chemotherapy consisted of the third generation new drug got the disease in control （CR＋PR＋SD）.In this study, we retrospectively reviewed our data to investigate the difference of survival between patients of disease control and progression （PD）, and disease response （CR＋PR） and stable （SD）, to identify the prognosis factor correlated with survival. Methods In our retrospective study, 118 patients with stage ⅢB （with malignancy pleural fluid） and IV NSCLC were identified who received the third generation new drug-based platinum or non-platinum regimens, the response of first-line chemotherapy were complete response （CR）, partial response （PR）, stable disease （SD） and progression disease （PD） according to RECIST criteria based on the records on the imaging reports papers. Results After first-line chemotherapy, 86 （72.9%） patients [CR2 （1.7%）, PR47 （39.8%）, SD37 （31.4%）） had disease control and 33 （27.1%） patients had progression disease. The median survival time of CR＋PR＋SD arm was significantly longer than PD arm （17.8 months vs 8.4 months, P=0.001）, but there was no significant difference between CR＋PR arm and SD arm （18.1 months vs 15.5 months, P=0.917）, the PFS between two arms were no significantly different too （7.1 months vs 6.9 months, P=0.622）. The Cox regression analysis shows that stage （ⅢB or Ⅳ）, chemotherapy lines （less than three lines or more than four lines） and disease control or not after first-line chemotherapy were independently prognosis factor of overall survival. Conclusion Our data shows that the survival of response and stable disease patients are better than that of patient with progression disease, the survival benefit of patients with stable disease and responses are no significantly difference.