重组改构人肿瘤坏死因子治疗晚期肺癌癌性胸腔积液疗效的影响因素分析

Factors affecting the efficacy of rmhTNF for advanced lung cancer with maglignant pleural effusion

目的:分析影响重组改构人肿瘤坏死因子(Recombinant mutant human tumor necrosis factor,rmhTNF)治疗晚期肺癌癌性胸腔积液疗效的因素。方法:回顾性分析我科应用rmhTNF治疗晚期肺癌癌性胸腔积液198例病人的临床资料,分析年龄、性别、病理类别、胸水部位、胸水量、肿瘤远处转移、KPS评分、治疗药物剂量(小剂量rmhTNF500万IU组、大剂量rmhTNF1500万IU组)、全身化疗等因素对肺癌癌性胸水疗效的影响,对有意义的因素进一步采用非条件Logistic回归分析。结果:198名患者中CR53例,PR95例,总有效率为74.7%。单因素分析显示年龄、胸水部位、胸水量、KPS评分、治疗药物剂量、辅助化疗等对肺癌胸水的疗效有影响;多因素分析显示治疗药物剂量、KPS评分、胸水量与疗效有关。结论:治疗药物剂量、KPS评分、胸水量是rmhTNF治疗肺癌恶性胸腔积液的独立的影响因素。大剂量rmhTNF1500万IU、KPS评分>60,胸水量少的患者疗效好。

Objective： To investigate the factors affecting the curative effect of recombinant mutant human tumor necrosis factor （rmhTNF） on patients with malignant pleural effusion caused by advanced lung cancer. Methods： The data of 198 patients were reviewed. Patients were assigned into two groups. One was treated with 5 million IU （low dose） ,another with 15 million IU rmhTNF（high dose）. The clinical efficacy of rmhTNF was analyzed with test and the prognostic factors of patients were calculated by multivariate unconditional logistic regression analysis. Results： In 198 patients treated with rmhTNF,the number of patients with complete response （CR） was 53, the number of patients with partial response （PR） was 95, the response rate being 74.7%. Age and Karnofsky Performance Score （KPS） of patients, location and quantity of malignant pleural effusion, dose of rmhTNF and neoadjuvant chemotherapy were associated with the clinical efficacy of rmhTNF. Dose of rmhTNF, KPS and quantity of malignant pleural effusion were selected as prognostic factors in the multivariate analysis. Conclusion： In treating malignant pleural effusion caused by advanced lung cancer, dose of rmhTNF, KPS and quantity of pleural effusion are independent prognostic factors. The patients （KPS 〉 60, treated with high dose rmhTNF and low quantity of pleural effusion ） present fine clinical effect.