老年晚期非小细胞肺癌患者化疗疗效及生存分析

The analysis of curative effect and survival of advanced non-small cell lung cancer in elderly patients

目的分析并探讨老年晚期非小细胞肺癌（NSCLC）患者应用第3代化疗药物的疗效及生存情况。方法回顾性分析69例有明确病理诊断的Ⅲb~Ⅳ期老年NSCLC患者,其中44例应用第3代化疗药物（化疗组）,25例应用最佳支持治疗（BSC组）,对两组病例的预后进行随访,采用Kaplan-Meier方法进行疗效分析及生存分析。结果化疗组较BSC组可显著延长生存的中位生存时间（mST9.4个月vs.4.8个月,P=0.042）,但序贯放化疗与单独化疗、BSC比较,生存时间无明显差异;以铂类为基础的联合化疗以及化疗周期≥4对于该组老年患者是可以接受的,分别较单药化疗（mST21.3个月vs.6.3个月,P=0.015）或化疗周期〈4（中位生存时间34.6个月vs.8.8个月,P=0.002）的患者有明显的生存优势。疗效评估为病情稳定或部分缓解均比疾病进展有更好的生存时间。化疗组最常见不良反应为骨髓抑制,各年龄段对比无显著差异。结论对PS评分0或1分的Ⅲb~Ⅳ期老年NSCLC患者,一线化疗可显著延长生存时间,无严重药物不良反应。

Objective To investigate curative effect and survival condition of the 3rd generation chemotherapy agents in treating elderly patients with advanced non-small cell lung cancer.Methods A retrospective analysis were performed using the clinical data of 69 elderly patients with non-small cell lung cancer who was staged Ⅲb~Ⅳ.Forty-four selected patients were treated with the 3rd generation chemotherapy agents and others received BSC.Two groups＇ prognosis were observed in follow-up visits periods.Kaplan-Meier method was used to analyse curative effect and survive.Results Chemotherapy alone was selected as the first line treatment which showed a significant higher survival time when compared to BSC（median survival time 9.4m vs.4.8m,P= 0.042）,but not to sequential chemoradioetherapy.Most of our patients were tolerant to platinum-based chemotherapy or 4 cycles of planned standard chemotherapy and a significant elongation of survival time when compared with single agent chemotherapy（median survival time 21.3m vs.6.3m,P=0.015） or4cycles chemotherapy（median survival time34.6m vs.8.8m,P=0.002）.Whatever response evaluation was defined SD（median survival time 21m） or PR（median survival time 30.4m）,survival time was significant longer than PD（median survival time 7.9m）.The most common drug toxicity in chemotherapy arm was myelosuppression,but significant difference was not found in three age groups.Conclusions First line chemotherapy could improve the survival for stage Ⅲb~Ⅳpatients who PS scored 0 or 1.Adverse effects of drugs were acceptable.