吉西他滨联合奥沙利铂或顺铂治疗非小细胞肺癌的临床疗效观察

Clinical research of gemcitabine combined with oxaliplatin or cisplatin in the treatment of non-small cell lung cancer

目的：比较吉西他滨联合奥沙利铂与吉西他滨联合顺铂治疗非小细胞肺癌（ NSCLC）患者的临床效果。方法2013年6月-2014年6月收治确诊的非小细胞肺癌患者68例，根据联合用药不同分为奥沙利铂组与顺铂组各34例。奥沙利铂组患者给予吉西他滨1000mg/ m^2，d1、d8＋奥沙利铂130mg/ m^2，d1，静脉滴注，3周为1个疗程；顺铂组给予吉西他滨1000mg/ m^2，d1、d8＋顺铂25mg/ m^2，d 1、2、3，静脉滴注，3周为1个疗程。2组均治疗2个疗程，随访6~24个月，比较2组临床疗效、近期不良反应、1年生存率。结果奥沙利铂组总有效率为41.2％（14/34），顺铂组为35.3％（12/34），2组比较差异无统计学意义（P ﹥0.05）。奥沙利铂组患者中位 PFS、OS 分别为24.5周、44.6周，顺铂组分别为18.2周、36.5周，2组中位 PFS 和中位 OS 比较差异无统计学意义（P ﹥0.05）。奥沙利铂组1年生存率为47.0％（16/34），顺铂组为41.2％（14/34），2组比较差异无统计学意义（P ﹥0.05）。2组患者不良反应主要表现为骨髓抑制、胃肠道反应和神经毒性等，以1~2级为主。奥沙利铂组1~2级神经毒性发生率为79.4％（27/34），高于顺铂组35.3％（12/34）（P ＜0.01），而3~4级不良反应发生率顺铂组为52.9％（18/34），高于奥沙利铂组的20.6％（7/34）（P ＜0.01），2组比较差异均有统计这意义（P ﹥0.05）。结论吉西他滨联合顺铂或奥沙利铂对非小细胞肺癌患者临床疗效相当，但联合奥沙利铂不良反应少，因而患者耐受性好，临床应用更安全。

Objective To compare the clinical effect of gemcitabine combined with oxaliplatin and gemcitabine com-bined cisplatin in the treatment of non-small cell lung cancer（NSCLC）. Methods From June 2013 to June 2014,68 cases of patients with NSCLC were divided into oxaliplatin groups and cisplatin group,each of 34 cases,according to different drug com-bination. Oxaliplatin groups was treated with gemcitabine 1000mg/ m^2 ,d1,8 ＋ oxaliplatin 130mg/ m^2 ,d l,intravenous drip,3 weeks for one period of treatment;Cisplatin group was treated with gemcitabine 1000mg/ m^2 ,d1,8 ＋ cisplatin 25mg/ m^2 ,d 1,2, 3,intravenous drip,3 weeks as a course of treatment. Both groups were treated for 2 courses and followed up for 6 ~ 24 months. The clinical curative effect,short-term adverse reaction,1 year survival rate of 2 groups were compared. Results The total effective rate of the oxaliplatin group was 41. 2%（14 / 34）,while the cisplatin group was 35. 3%（12 / 34）,there was no statistically significant difference（P ﹥ 0. 05）. The median PFS,OS of oxaliplatin group was respectively 24. 5 and 44. 6 weeks, while the cisplatin group were 18. 2,36. 5 weeks,there was no statistical significance between 2 groups（P ﹥ 0. 05）. The 1 year survival rate of oxaliplatin group was 47. 0%（16 / 34）,while the cisplatin group was 41. 2%（14 / 34）,the difference was no statistical significance（ P ﹥ 0. 05）. The main adverse reaction were bone marrow suppression,gastrointestinal reaction and nerve toxicity,and they were mostly 1 ~ 2 level. The incidence of 1 ~ 2 levels nerve toxicity in oxaliplatin group was 79. 4%（27 / 34）,which was higher than 35. 3% of cisplatin group（12 / 34）,the difference was statistically significant（P 〈 0. 01）. The grade 3 ~ 4adverse reaction incidence of cisplatin group was 52. 9%（18 / 34）,which was higher than 20. 6% of oxaliplatin group（7 / 34）,the difference was statistically significant（P 〈 0. 01）. Conclusion The clinical curative effect of gemcitabine combined with cisplatin or oxaliplatin is quite in patients with NSCLC,but the oxaliplatin has less adverse reaction,and good tolerance,so the clinical application of which is more secure.