晚期肺腺鳞癌不同化疗方案疗效分析

Efficacy of chemotherapy in patients with advanced adenosquamous carcinoma of lung

目的探讨晚期肺腺鳞癌患者一线、二线化疗方案选择及其疗效。方法回顾性分析广西医科大学附属肿瘤医院2008年1月1日-2014年12月31日初诊为晚期肺腺鳞癌的36例患者的临床资料。36例患者一线化疗均为含铂两药方案,其中吉西他滨联合铂类（GP组）23例,铂类联合长春瑞滨、培美曲塞或紫杉醇类（非GP组）13例。GP组与非GP组患者的性别、年龄、ECOG PS评分、临床分期、原发灶位置、吸烟史等临床特征具有可比性。36例患者一线化疗进展后均进行二线化疗,其中接受培美曲塞20例,多西紫杉醇16例,接受培美曲塞或多西紫杉醇的两组患者二线化疗前的性别、年龄、ECOG PS评分、临床分期、原发灶肿瘤位置、吸烟史等特征具有可比性。采用SPSS 17.0软件进行统计分析,Kaplan-Meier方法进行生存分析,Log-rank检验判断生存情况差异。结果 36例患者中男性24例,中位年龄54岁,ECOG行为能力评分0-1分28例,ⅢB期、Ⅳ期分别为15和21例。一线化疗GP组的客观缓解率为47.8%（11/23例）,高于非GP组的23.1%（3/13例）,但差异无显著性（P=0.175）;GP组的中位无进展生存时间（PFS）为4.6个月,高于非GP组的2.6个月,而差异亦无显著性（P=0.412）;二线化疗培美曲塞组的客观缓解率、中位PFS分别为80.0%和10.0个月,均显著高于多西紫杉醇组的12.5%和1.0个月（P=0.000或P=0.000）。在总生存（OS）方面,至2015年4月30日随访截止,一线使用GP方案且二线使用培美曲塞方案患者的OS为25.0个月,显著高于其他一、二线化疗组合方案的12.5个月（P=0.000）。结论晚期肺腺鳞癌患者的化疗以一线选择吉西他滨联合铂类,二线选择培美曲塞疗效最佳,值得进一步研究。

Objective To investigate the efficacy of chemotherapy for advanced adenosquamous carcinoma（ASC）of the lung.Methods The data of patients with stageⅢB orⅣadenosquamous carcinoma of the lung were retrospectively analyzed regarding objective response of chemotherapy,progression-free survival,overall survivalin and safety.All of the 36 patients were with chemotherapy containing Platinum scheme for the first-line regimen.23 patients were Gemcitabine combined cisplatin（GP）,and the rest of 13 patients were Platinum combined vinorelbine,pemetrexed,or paclitaxel class（non-GP）.The gender,age,ECOG PS scores,clinical stage,primary site locations,smoking history and other clinical features of GP groups were comparable with non-GP groups.After the first-line regimen,all patients were continued the second-line regimen.Among them,20 patients were received pemetrexed,the rest of the 16 patients were received docetaxel.The two groups with second-line chemotherapy regimen were compared with ECOG PS,age,gender rating,clinical stage,metastatic tumor location,smoking history and other characteristics.Results 36 patients were included in this study with median age was 54,there were 24 males,an Eastern Cooperative Oncology Group performance status of 0to 2,15 cases with stage IIIB disease.All patients received platinum-based doublet regimens as first-line Chemotherapy.The objective response rate（ORR）and progression-free survival（PFS）of gemcitabine plus cisplatin（GP regimen）were 47.8%and 4.6months,respectively,which were higher than other schemes but not reach significant statistically.As for second-line chemotherapy,the ORR and PFS of pemetrexed was 80.0%and 10.0months,respectively.Both of them were significantly higher than that of the docetaxel group（P=0.000）.The overall survival（OS）of those received GP regimen as first-line and pemetrexed as second-line chemotherapy was 25.0months,which was significantly longer than that of other combination of first-line and second-line regimens（P=0.000）.Conclusion First-line chemotherapy with gemcitabine plus cisplatin followed by pemetrexed as second-line chemotherapy may improve the long-term outcomes of patients with advanced adenosquamous carcinoma of the lung.