老年肺癌患者术后辅助化疗临床意义回顾性分析

Adjuvant chemotherapy for elderly patients with NSCLC

目的:了解含铂方案术后辅助化疗对老年非小细胞肺癌患者生存期的影响。方法:回顾性分析2001-01-2004-12上海户籍≥65岁的老年非小细胞肺癌手术患者314例。分为年轻老年人(65～<70岁)、中等老年人(70～<75岁)、高龄老年人(≥75岁)3组。结果:术后愿意接受辅助化疗的患者仅29.9%。接受辅助化疗与未接受化疗者相比,未明显延长生存期(P=0.6365),中位生存期分别为(39.4±8.39)和(25.70±6.83)个月。其中61.7%患者能完成3/4个周期,完成≥3个周期者比未能完成者有显著的生存获益(P=0.0336),中位生存期分别为(86.60±26.99)和(23.40±6.01)个月,降低死亡风险(P=0.002,HR=0.806)。经Cox多因素分析,年龄不是影响生存的主要因素,而病理分期及含铂方案术后辅助化疗(≥3个周期)是影响生存的主要因素。结论:老年非小细胞肺癌患者术后能接受≥3个周期化疗者可明显延长生存期,降低死亡风险。高龄患者对含铂方案辅助化疗耐受性较差。

OBJECTIVE：To undsrstand the effect of the cisplatin-based adjuvant chemotherapy on a consistent survival for elderly patients with NSCLC.METHODS：A total of 314 elderly resected patients with NSCLC were enrolled from Jan.2001 to Dec.2004,and retrospectively analyzed the effect of the adjuvant chemotherapy on survival and compared the treatment characteristics and chemotherapy toxicity of 3 groups：65-70 yr.（younger）,70-75 yr.（elderly）and ≥75 yr.（more elderly）.RESULTS：Only 29.9% elderly patients received the adjuvant chemotherapy,and adjuvant chemotherapy showed no significant survival for elderly patients（P=0.636 5）,and the median survival time was（39.4±8.39）and（25.70±6.83）months.If the patients finished 3 cycles or 4,they had a significant survival benefit than those did not（P=0.033 6）,and the median survival time was（86.60±26.99）months and（23.40±6.01）months,respectively,reducing the mortality risk（P=0.002,HR=0.806）.The COX multivariate analysis showed that age was not a factor influencing the survival,only the pathological staging and cisplatin-based chemotherapy（≥3 cycles）were the factors influencing the survival.CONCLUSION：The cisplatin-based adjuvant chemotherapy for selected elderly resected patients with lung cancer who can be expected to finish 3 cycles or more have a significantly suvival,reducing the mortality risk.