敏感复发小细胞肺癌二线化疗疗效及生存分析

Analysis of efficacy and survival of patients receiving second-line treatment for sensitive recurrent small-cell lung cancer

目的:本研究旨在比较拓扑替康、含铂联合化疗和其他单药化疗用于敏感复发小细胞肺癌(small-celllung cancer,SCLC)患者二线化疗的疗效和安全性。方法:回顾性分析83例敏感复发SCLC患者接受二线化疗的疗效和生存情况,并采用COX比例风险模型进行预后的相关因素分析。结果:拓扑替康组、含铂联合化疗组和其他单药化疗组的中位无进展生存期(progression-free survival,PFS)分别为2.80、4.07和1.93个月(P=0.007),二线化疗后的中位总生存期(overall survival,OS)分别为8.07、10.57和7.27个月(P=0.021),Ⅲ～Ⅳ度不良反应发生率分别为47.6%、69.2%和30.0%(P=0.033)。COX比例风险模型分析结果显示,一线化疗疗效(有效与稳定/进展:风险比为1.27,P=0.013)、二线化疗前体能状况评分(0～1分与2分:风险比为1.36,P=0.019)和二线化疗前肿瘤分期(局限期与广泛期:风险比为2.16,P=0.006)是二线化疗OS的独立影响因素。结论:一线化疗有效、体能状况评分为0～1分、二线化疗前局限期患者更能从二线化疗中获益。与拓扑替康和其他单药化疗相比,二线含铂联合化疗的PFS和OS更具优势。

Objective： This study is aimed to retrospectively evaluate and compare the efficacy and safety among topotecan, platinum-based rechallenge and other single agent therapies as second-line chemotherapy in patients with sensitive recurrent SCLC （small-cell lung cancer）. Methods： Eighty-three patients with sensitive recurrent SCLC were recruited in this study and their clinical records and follow-up information were retrospectively reviewed. The efficacy of the second-line chemotherapy was evaluated, and the survival of these patients was analyzed. COX proportional hazards model analysis was conducted to find out the prognosis-related factors. Results： The median PFS （progression-free survival） in topotecan, platinum-based rechallenge and other single agent groups were 2.80, 4.07 and 1.93 months, respectively （P = 0.007）; the median OS （overall survival） from the initiation of second-line chemotherapy in these three groups were 8.07, 10.57 and 7.27 months, respectively （P = 0.021）; the rates of grades Ⅲ-Ⅳ toxicities in these three groups were 47.6%, 69.2% and 30.0%, respectively （P = 0.033）. The COX proportional hazards model analysis revealed that the factors of response to first-line chemotherapy （response vs stable disease/progression; hazard ratio = 1.27, P = 0.013）, performance status score before second-line chemotherapy （0-1 vs 2; hazard ratio = 1.36, P = 0.019）, and staging before second-line chemotherapy （limited vs extensive; hazard ratio = 2.16, P = 0.006） were independent prognostic predictors of OS after second-line chemotherapy. Conclusion： The sensitive recurrent SCLC patients who were classified as limited-stage SCLC and having a therapeutic response to first-line chemotherapy and a performance status score of 0-1 may benefit from the second-line chemotherapy. Platinum-based rechallenge as a second-line chemotherapy regimen has an advantage of prolonged PFS and OS as compared with topotecan or other single agent therapy.