TS和RRM1表达与培美曲塞、吉西他滨联合卡铂治疗晚期非鳞非小细胞肺癌疗效的关系

The Role between the Expression of TS and RRM1 and Efficacy of Pemetrexed and Gemcitabine Plus Carboplatin for Advanced Non Squamous Non-small Cell Lung Cancer

目的探讨胸苷酸合成酶(TS)和核苷酸还原酶M1(RRM1)的表达与培美曲塞、吉西他滨联合卡铂治疗晚期非鳞非小细胞肺癌疗效的关系。方法选取晚期非鳞非小细胞肺癌患者98例,其中接受培美曲塞联合卡铂治疗患者49例(A组),接受吉西他滨联合卡铂治疗患者49例(B组)。免疫组化检测所有肿瘤标本中TS和RRM1的表达,并分析其表达与化疗疗效的关系。结果培美曲塞组TS-患者总有效率为64.3%,显著高于同组TS+患者总有效率42.9%,差异具统计学意义(P<0.05);培美曲塞组RRM1+和RRM1-患者总有效率分别为52.1%和57.7%,差异无统计学意义(P>0.05)。吉西他滨组RRM1-患者总有效率为57.7%,显著高于同组RRM1+患者总有效率47.8%,差异具统计学意义(P<0.05);吉西他滨组TS+和TS-患者总有效率分别为50.0%和56.0%,差异无统计学意义(P>0.05)。培美曲塞组TS-患者胃肠道毒副反应和血液毒副反应发生率分别为17.9%和21.4%,显著低于TS+患者(P<0.05);吉西他滨RRM1-患者胃肠道毒副反应和血液毒副反应发生率分别为23.1%和26.9%,显著低于RRM1+患者(P<0.05)。2组患者不良反应总发生率相比较,培美曲塞组患者相对能较好耐受,差异具统计学意义(P<0.05)。培美曲塞组患者FACT-L评分显著优于吉西他滨组患者,差异具统计学意义(P<0.05)。结论 TS-患者接受培美曲塞治疗有较好临床获益,RRM1-患者接受吉西他滨治疗临床获益较好,且培美曲塞化疗方案相对吉西他滨有较好临床耐受性,毒副作用相对较低,治疗后患者FACT-L评分较高。

Objective To analyze the relationship between the expression of thymidylate synthase （TS） and ribonucleotide reduetase M1 （ RRM1 ） and efficacy of pemetrexed and gemcitabine combined with carboplatin in the treatment of advanced non squamous non-small cell lung cancer. Methods 98 patients with advanced non sqnamous non-small cell lung cancer were selected ,49 patients in group A received pemetrexed combined with carboplatin ,49 patients in group B received gemcitabine combined with carboplatin, to detect the expression of TS and RRMI of all tumor samples by immunohistochemical method, and to analyze the relationship between the expression and efficacy of chemotherapy. Results The pemetrexed group TS - patients total efficiency was 64.3% , significantly higher than that of TS ＋ patients （ 42.9% ） , the difference was statistically significant （ P 〈 0.05 ） ;pemetrexed group RRM1 ＋ and RRM1 -patients total efficiency was 52.1% and 57.7% respectively, the difference was not significant （ P 〉 0.05 ）. Gemcitabine group RRM1 - patients total efficiency was 57.7% , significantly higher than that of RRM1 ＋ patients ,47.8% （P 〈 0.05 ） ; gemcitabine group TS ＋ and TS - patients total effective rates were 52.0% and 56.0% respectively, the difference was not significant（ P 〉 0.05 ）. The incidence of pemetrexed group TS - patients gastrointestinal toxicity and blood toxicity rates were 17.9% and 21.4% respectively,which was significantly lower than TS ＋ patients （P 〈 0.05 ）, the incidence of gemcitabine group RRM1 - patients, gastrointestinal toxic side reaction and blood poisonous side reaction rates were 23.1% and 26.9% ,significantly lower than RRM1 ＋ patients （P 〈0.05）. compared adverse reaction rates between the 2 groups, the pemetrexed group were relatively well tolerated, the difference was statistically significant （ P 〈 0.05 ）. The FACT-L scores of pemetrexed group were significantly better than gemcitabine group, the difference was statistically significant （ P 〈 0.05 ）. Conclusion TS - patients received pemetrexed treatment have better clinical benefit and patients with RRM1 - received gemcitabine treatment have better clinical benefit, and pemetrexed regimen relative gemcitabine has better clinical tolerance and side effects is relatively low and FACT-L scores better than gemcitabine group after treatment.