70岁以上老年晚期非小细胞肺癌患者以铂类为主双药化疗的疗效和安全性评价

Evaluation of efficacy and safety of platinum-based doublet chemotherapy for advanced non-small cell lung cancer patients aged 70 years or over

目的:评价≥70岁老年晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者接受以铂类为主双药化疗的疗效和安全性。方法:167例Ⅲ～Ⅳ期NSCLC患者根据年龄分为≥70岁老年双药联合化疗组(以铂类为主双药化疗)、≥70岁老年最佳支持治疗组(支持治疗)和<70岁非老年对照组(以铂类为主双药化疗),化疗至少2个周期。评价近期疗效和不良反应,并进行随访以观察无进展生存和总生存情况。结果:老年双药联合化疗组和非老年对照组的化疗近期总有效率分别为33.3%和35.5%(P=0.811);两组的中位无进展生存期分别为124d和140d(P=0.122),中位生存时间分别为337d和367d(P=0.173),均优于老年最佳支持治疗组(分别为87d和218d,P均<0.05)。老年双药联合化疗组与非老年对照组的1年生存率(分别为42%和53%)和化疗前后美国东部肿瘤协作组(Eastern Cooperative Oncology Group,ECOG)体能状况(performance status,PS)评分改善率(分别为41%和48%)差异均无统计学意义,但与老年最佳支持治疗组的1年生存率(15%)和ECOGPS评分改善率(13%)相比,差异均有统计学意义(P均<0.05)。老年双药联合化疗组Ⅲ级以上白细胞减少和恶心、呕吐等不良反应发生率与非老年对照组相似。结论:老年晚期NSCLC患者ECOGPS评分≤2分可从以铂类为主的双药化疗中获益,取得与非老年患者相近的近期疗效、生存时间和生活质量改善率,且不良反应未见明显增加。

Objective：To evaluate the efficacy and safety of platinum-based doublet chemotherapy for patients aged ≥70 years old with advanced non-small cell lung cancer（NSCLC）.Methods：One hundred and sixty-seven patients with NSCLC at stage Ⅲ/Ⅳ were divided into three groups：patients aged ≥70 years old receiving platinum-based doublet chemotherapy（group A）,patients aged ≥70 years old receiving best supportive care（group B） and patients aged 70 years old receiving platinum-based doublet chemotherapy（group C）.At least two cycles of chemotherapy were required.The short-term response and the adverse effects were observed.All patients were followed up,and the progression-free survival（PFS） and the overall survival（OS） were calculated.Results：There were no significant differences in short-term response rate（33.3% vs 35.5%,P=0.811）,median PFS（124 d vs 140 d,P=0.122） and median survival（337 d vs 367 d,P=0.173） between group A and group C.The median PFS and median survival of group B were 87 d and 218 d,respectively,which were both shorter than those of group A and group C（P0.05）.The one-year survival rate（42% vs 53%） and the rate of Eastern Cooperative Oncology Group performance status（ECOG PS） score improvement（41% vs 48%） after chemotherapy between group A and group C were not significantly different,but the group B had a lower one-year survival rate（15%） and a lower ECOG PS score improvement rate（13%） as compared with group A and group C（P0.05）.The incidence rates of grade Ⅲ/Ⅳ leukopenia and nausea/vomiting were similar in group A and group C.Conclusion：The elderly patients（≥70 years old） with advanced NSCLC,whose ECOG PS score was ≤2,may benefit from the platinum-based doublet chemotherapy,and the short-term response,survival and the improvement in life quality of these patients were similar to the patients younger than 70 years old with advanced NSCLC receiving the same chemotherapy.The side effects of chemotherapy occurred in the elderly and non-elderly patients were also similar.