不同含铂治疗方案在晚期非小细胞肺癌患者中的应用效果

Effect of different platinum-based combination chemotherapies for patients with advanced non-small-cell lung cancer

目的比较不同含铂的化疗方案对晚期非小细胞肺癌（NSCLC）的疗效及安全性。方法选取2009年1月～2013年1月首都医科大学附属北京潞河医院初治的164例晚期NSCLC患者为研究对象，164例患者根据一线化疗方案分为紫杉醇组（紫杉醇联合铂类，n=78）、吉西他滨组（吉西他滨联合铂类，n=49）和多西他赛组（多西他赛联合铂类，n=37）。比较三组的疗效及不良反应，并用Kaplan—Meier法方法评估生存状况。结果紫杉醇组、吉西他滨组和多西他赛组化疗后达到客观有效的比例分别为43．6％、46．9％、37．8％，达到疾病控制的比例分为87．2％、83．7％及81．1％，差异无统计学意义（均P〉0．05）。不良反应主要是血液学毒性，其次是脱发、胃肠道毒性、神经毒性、肾脏毒性、心脏毒性和肝脏毒性，紫杉醇组的神经毒性的发生率明显高于另外两组（P〈0．05），吉西他滨组的肾脏毒性的发生率明显高于另外两组（P〈0．05）。紫杉醇组、吉西他滨组和多西他赛组的中位无进展生存时间分别为5．7、5．9、3．1个月，多西他赛组明显短于其他两组（P〈0．05）。结论紫杉醇、吉西他滨以及多西他赛3个药物分别联合铂类的一线化疗方案在治疗晚期NSCLC上均能取得较满意的疗效，且不良反应均较轻，但紫杉醇及吉西他滨在控制疾病的进展方面好于多西他赛。

Objective To compare the efficacies and safety of different platinum-based combination chemotherapies for patients with advanced non-small-cell lung cancer （NSCLC）. Methods 164 patients initially treated in Beijing Luhe Hospital, Capital Medical University from January 2009 to January 2013 were enrolled for study. According to the first- line chemotherapy regiments, 164 cases were divided into Paclitaxel group （Paclitaxel combined with platinum, n=78）, Gemcitabine group （Gemcitabine combined with platinum, n=49） and Docetaxel group （docetaxel combined with plat- inum, n=37）. The efficacies and adverse reactions were compared among three groups, and Kaplan-Meier method was used to evaluate the survival situation. Results The objective response rate （ORR） of Paclitaxel group, Gemcitabine group and Docetaxel group were 43.6%, 46.9% and 37.8%, and the disease control rate （DCR） of three groups were 87.2%, 83.7% and 81.1%. There were no signifieam differences in ORR an DCR among three groups （all P 〉 0.05）. Adverse reac- tions were mainly hematological toxicity, followed by alopeeia, gastrointestinal toxicity, neurotoxicity, renal toxicity, ear- diac toxicity and liver toxicity. The incidence of neurotoxicity of Paclitaxel group was significantly higher than that of the other two groups （P 〈 0.05） and the incidence of renal toxicity of Gemcitabine group was significantly higher than that of the other two groups （P 〈 0.05）. The median progression-free survival of Paclitaxel group, Gemeitabine group and Do- cetaxel group were respectively 5.7, 5.9 and 3.1 months, and Docetaxel group were significantly lower than those of the other two groups （P 〈 0.05）. Conclusion Three first-llne chemotherapy regiments including Paclitaxel, Gemcitabine and Docetaxel respectively combine with platinum can obtain satisfactory curative effect in the treatment of advanced NSCLC, and the adverse reactions are mild. But Paclitaxel and Gemcitabine are better than Docetaxel in the control of progression of the disease.