比较4种不同化疗方案一线治疗晚期非小细胞肺癌的临床疗效

目的比较4种化疗药物分别联合顺铂治疗晚期非小细胞癌（NSCLC）患者的疗效。方法2005年lOPl至2012年8月经病理确诊为晚期非小细胞肺癌患者151例。151例患者中，MVP（丝裂霉素＋长春地辛＋顺铂）组38例，TP（紫杉醇＋顺铂）组46例，GP（吉西他滨＋顺铂）组31例，DP（多西他赛＋顺铂）组36例。化疗3~4周为1个疗程，2个疗程后评价疗效、生活质量及不良反应。结果MVP组、TP组、GP组、DP组的有效率分别为34．2％、45．7％、48．4％、44．4％；中位生存期分别为8．9、10．8、12．1、11．5个月；12生存率分别为28．9％、34．8％、35．5％、33．3％；2年生存率分别为10．5％、13．O％、12．9％、11．1％。MVP组治疗效果及患者生存率略低于其他3组，但各组差异无统计学意义。GP组综合获益最高及临床症状改善最显著，分别为77．1％与80．6％，其次分别为TP组、DP组和MVP组，各组差异无统计学意义。主不良反中TP组脱发反应发生率（50％）显著高于其他3组（P〈0．05）。结论紫杉醇、吉西他滨、多西他赛分别联合顺铂治疗晚期非小细胞肺癌疗效及生存率相当，其中紫杉醇联合顺铂引起脱发反应发生率显著增高。

Objective To evaluate the treatanent efficacy of four chemotherapy regimens for advanced non small cell lung cancer （ NSCLC ） . Methods The clinical data of 151 cases diagnosed as advanced NSCLC from 2005 to 2012 were collected and retrospectively analyzed. A total of 151 patients were divided into four groups, with 38 cases in MVP group, 46 cases in TP group, 31 cases in GP group and 36 cases in DP group. The clinical efficacy, toxic response and survival rate were evaluated after two treatment cycles. Results The MVP, TP, GP and DP group each gave a response rate of 34.2%, 45.7%, 48.4% and 44.4%, respectively. The median survival time were 8.9, 10.8, 12.1 and 11.5 months. One-year survival rates were 28.9%, 34.8%, 35.5% and 33.3%, while two-year survival rates were 10.5%, 13.0%, 12.9% and 11.1%, respectively. The clinical efficacy and survival rate of MVP group were generally lower than other groups without statistically significant difference. GP group has the highest comprehensive benefit rate and clinical symptoms improvement rate, giving 77.1% and 80.6%, followed by TP, DP and MVP group. No significant difference was detected between the four groups. Major toxic effects included nausea/vomiting, hair loss, phlebitis, reduction of white blood cell, platelet count and hemoglobin. The rate of hair loss in TP group （ 50% ） was significantly higher than MVP, GP and DP group （ P〈0.05 ） . No significant difference of other side-effects were detected among patients from the four groups. Conclusion The clinical efficacy and survival rate of MVP, TP, GP and DP chemotherapy regimen showed no significant difference, among which the TP regimen has a significantly higher rate of hair loss side-effect.