培美曲塞联合顺铂对吸烟与不吸烟晚期肺腺癌患者的临床疗效观察

Clinical Study on Efficacy of Pemetrexed Combined Cisplatin for Smoking and Non-smoking Patients in Advanced Lung Adenocarcinoma

目的观察吸烟对肺腺癌患者培美曲塞联合顺铂治疗疗效的影响。方法分析2010年2月-2012年2月徐州医学院附属医院肿瘤科收治的83例经病理学或细胞学确诊的初治ⅢB、Ⅳ期肺腺癌患者。吸烟组33例,不吸烟组50例,初治采用培美曲塞联合顺铂方案（培美曲塞500 mg·m^-2第1天静脉滴注,顺铂30 mg·m^-2第1-3天静脉滴注）化疗,21天为1个周期,每治疗两个周期后评价疗效,直至病情进展。近期疗效评价指标为疾病控制率（DCR）,远期疗效评价指标为疾病进展时间（TTP）和1年生存率,毒副反应评价指标为骨髓抑制毒性、消化道反应等。结果吸烟组与不吸烟组DCR分别为60.6%和76.0%;TTP分别为（5.7±1.6）月和（6.7±1.8）月,1年生存率分别为24.24%和46.0%。两组DCR比较（χ2=2.238,P=0.135）,差异无统计学意义,TTP（t=2.55,P=0.013）及1年生存率（χ2=4.022,P=0.045）的差异有统计学意义。吸烟组与不吸烟组骨髓抑制毒性、消化道反应、口腔炎/咽炎、感染发生率的差异均无统计学意义（P〉0.05）。结论不吸烟晚期肺腺癌患者一线应用培美曲塞治疗较吸烟患者可有更明显的远期获益。

Objective To evaluate the effects of smoking on efficacy of pemetrexed combined cisplatin in advanced lung adenocarcinoma. Methods A total of 83 cases from the department of oncology of Affiliated Hospital of Xuzhou Medical College between February 2010 and February 2012 were included. All patients were pathologically or cytologically diagnosed with IIIB, IV lung adenocarcinoma. There were 33 cases of smoking and 50 cases of non-smoking. All patients were under initial treatment in every three weeks method with pemetrexed 500 mg·m^-2 on day 1 and cisplatin 30 mg·m^-2 on day 1-3. Evaluation was performed at the end of every two cycles, until disease progression. The short-term efficacy evaluation contains complete remission（CR）, partial remission（PR）, stable disease（SD） and progression（PD）. Time to progress（TTP） and 1-year survival rate were used as the long-term efficacy evaluation. The toxicity mainly includes myelosuppression, gastrointestinal reactions. Results Compared the smoking group with the non-smoking group, their DCR, TTP and the 1-year survival rate were respectively 60.6% vs. 76.0%,（5.7±1.6） vs.（6.7±1.8） months, 24.24% vs. 46.0%. There was no statistic difference in DCR（χ2=2.238, P=0.135）, but there was statistically significant differences in TTP（t=2.55, P=0.013） and 1-year survival rate（χ2=4.022, P=0.045） between two groups. In addition, myelosuppression, gastrointestinal reactions, Stomatitis/pharyngitis and infection in the two groups were not statistically different（P〉0.05）. Conclusion The non-smoking patients with advanced lung adenocarcinoma may have a greater long-term benefit than those smoking under first-line therapy of pemetrexed.