EP/CE联合与不联合紫杉醇方案治疗复合性小细胞肺癌的临床价值

Comparison of therapeutic efficacy of different chemotherapeutic regimens on combined small cell lung cancer

目的:通过观察三药(紫杉醇+顺铂/卡铂+依托铂苷)和双药方案(顺铂/卡铂+依托铂苷)一线治疗复合性小细胞肺癌(combined small-cell lung CSCLC)的疗效及不良反应,比较两者的有效和安全性。方法:回顾性分析天津医科大学肿瘤医院2000年7月至2013年4月收治的62例经病理证实的复合性小细胞肺癌患者资料(19例接受三药、43例接受双药治疗),随时评价不良反应,每2周期评价疗效。结果:三药与双药方案的有效率分别为90%和53%,差异有统计学意义(P=0.033),疾病控制率分别为100%和86%,差异无统计学意义(P=0.212)。两组的中位无进展生存期(PFS)分别为10.5个月和8.9个月、中位生存时间(OS)分别为24.0个月和17.5个月,差异均无统计学意义(P=0.484;P=0.457)。三药方案组中Ⅳ度骨髓抑制和因严重的不良反应终止原方案治疗的发生率均高于双药方案组,差异有统计学意义(P=0.034;P=0.006)。结论:需慎用TEP/TCE等三药方案治疗CSCLC,顺铂/卡铂+依托铂苷暂时仍应为其一线治疗标准方案。

Objective：To compare the therapeutic and adverse effects of chemotherapeutic regimen based on three drugs （taxol＋carboplatin/cisplatin＋etoposide） and two drugs （carboplatin/cisplatin＋etoposide） on the combined small cell lung cancer （CSCLC）. Methods：A retrospective study was conducted based on the data of 62 CSCLC patients who were admitted to and treated at Tianjin Medical University Cancer Institute and Hospital between July 2000 and April 2013. Of the 62 patients, 19 received the three-drug regi-men and 43 received the two-drug regimen. All patients received at least two cycles of chemotherapy and completed follow-up proce-dures. For each patient, the therapeutic efficacy was evaluated every two cycles, and toxicity was evaluated every cycle. Results：The response rates between the three-drug and two-drug groups were statistically significant （90%vs. 53%, P=0.033）. However, no statisti-cal differences were observed in the disease control rate between the two groups （100% vs. 86%, P=0.212）. The three-drug regimen could induce a better median progression-free survival compared with the two-drug regimen, but with no statistical significance （10.5%vs. 9.8%, P=0.484）. Similarly, no statistical differences were noted in the median overall survival between the three-drug and two-drug groups （24.0%vs. 17.5%, P=0.457）. The incidence rates of grade IV bone marrow depression and the termination of the original regi-men owing to severe adverse reactions were both significantly higher in the three-drug group than in the two-drug group （26.3% vs. 7.0%, P=0.036;31.6%vs. 14.7%, P=0.004）. Conclusion：The two-drug regimen had almost the same survival rate and lower toxicity compared with the three-drug regimen. When using the TEP/TCE regimen, a close attention should be focused on its adverse reactions. The findings of this work showed that the two-agent regimen should be one of the standard treatments for CSCLC.