不同模式治疗局限期小细胞肺癌的疗效和安全性比较

Comparison of Effectiveness and Safety of Different Treatment Modes for Limited-stage Small Cell Lung

目的探讨不同治疗模式对局限期小细胞肺癌的近期疗效、不良反应和远期生存情况的影响。方法对采用不同综合治疗方式的171例局限期小细胞肺癌患者的临床资料进行回顾性分析。结果 171例患者中,同步放化疗组55例,序贯放化疗组66例,单纯化疗组50例。全组治疗有效率为73.1%,中位总生存期(OS)为23.5个月,中位无进展生存期(PFS)为15.2个月,1、3、5年生存率分别为76.2%、30.4%、16.3%。同步放化疗组、序贯放化疗组、单纯化疗组的治疗有效率分别为87.3%、71.2%、60.0%,中位OS分别为30.6、23.1、19.1个月,中位PFS分别为19.7、13.3、11.5个月,5年生存率分别为28.7%、13.6%、9.4%,3组间差异均有统计学意义(P均<0.05)。患者放化疗后的不良反应主要为骨髓抑制、放射性肺炎和放射性食管炎。同步放化疗组、序贯放化疗组、单纯化疗组的骨髓抑制发生率分别为92.7%、89.4%和92.0%,3组间差异无统计学意义(P=0.25)。同步放化疗组和序贯放化疗组Ⅰ～Ⅱ度放射性食管炎的发生率分别为94.5%和75.8%,差异有统计学意义(P=0.02),Ⅰ度放射性肺炎的发生率分别为47.2%和50.0%,差异无统计学意义(P=0.61)。单因素和多因素分析均表明,性别、ECOG评分、TNM分期、是否胸部放疗是预后的独立因素。结论同步放化疗是局限期小细胞肺癌治疗的优选方案,可延长局限期小细胞肺癌的OS和PFS,提高生存率的同时其大多可以耐受。

Objective To compare the effectiveness and safety of different treatment modes for limited- stage small cell lung cancer （SCLC） . Methods The clinical data of 171 SCLC patients who had received different therapies were retrospectively analyzed. Results Of these 171 patients, 55 had received concurrent radio- chemotherapy, 66 received sequential radiochemotherapy, and 50 received chemotherapy alone. For these 171 patients, the overall response rate （ORR） was 73. 1%, overall survival （OS） and progression-free sur- vival （PFS） were 23.5 months and 15.2 months, respectively, and the 1-, 3-, and 5-year survival rates were 76. 2%, 30. 4%, and 16. 3%, respectively. For the concurrent group, sequential group, chemotherapy alone group, the median OS were 30. 6, 23.1, and 19. 1 months, the median PFS were 19.7, 13.3, and 11.5 months, and the 5-year survival rate was 28. 7%, 13.6%, and 9. 4%, respectively （ all P 〈 O. 05 ） . The main toxic effects were myelosuppression, radiation pneumonia, and radiation esophagitis. The incidences of I -II grade myelosuppression were 92. 7%, 89.4%, and 92% in the concurrent group, sequential group, and chemotherapy alone group （P = 0. 25 ） . For concurrent group and sequential group, the incidence of I grade radiation pneumonia were 47.2% and 50%, respectively （ P = 0. 61 ）, whereas the incidence of I - II grade radiation esophagitis were 94. 5% and 75.8% （P = 0. 02） . Multivariate analysis showed that gender, ECOG score, TNM stage, and thoracic radiation therapy were the independent prognostic factors for SCLC. Conclusion Concurrent radiochemotherapy is the treatment of choice for SCLC patients because it can improve the survival with tolerable toxicities.