沙利度胺联合化疗治疗老年晚期非小细胞肺癌的临床观察

Clinical Observation of Thalidomide Combined Paclitaxel and Cisplatin in Treatment of Advanced Non-small Cell Lung Cancer

目的探讨沙利度胺联合紫杉醇加顺铂方案治疗晚期非小细胞肺癌(NSCLC)的临床疗效。方法选择2013年1月-2014年12月84例老年晚期NSCLC患者为研究对象,根据入院时间分为观察组和对照组各42例,对照组给予紫杉醇加顺铂(TP)方案化疗,观察组给予沙利度胺联合TP方案治疗。观察两组临床疗效、肿瘤标志物、不良反应等指标。结果观察组疾病控制率85.71%明显高于对照组64.29%(χ~2=5.143,P<0.05);观察组无进展生存时间、总生存时间均明显长于对照组(t=6.689,2.754,P<0.05);血清癌胚抗原(CEA)、癌抗原125(CA125)、细胞角蛋白19片段(CYFRA21-1)水平(t=16.646,15.125,16.428,P<0.05);恶心呕吐40.48%明显低于对照组76.19%,便秘、乏力或嗜睡发生率明显高于对照组(χ~2=11.020,6.158,4.414,P<0.05),两组白细胞减少、血小板减少、血红蛋白减少、周围神经毒性等比较无统计学意义(P>0.05)。结论沙利度胺联合紫杉醇加顺铂方案治疗有助于降低晚期非小细胞肺癌患者血清肿瘤标志物表达水平,提高临床疗效,但应预防便秘、乏力或嗜睡等不良反应。

Objective To discuss the clinical efficacy of thalidomide combined with paclitaxel plus cisplatin （TP） in treatment of advanced non-small cell lung cancer （NSCLC）. Methods 84 elderly patients with advanced NSCLC which admission time is January 2013 to December 2014 were randomly divided into TP group and TP plus thalidomide respectively, Both groups contained 42 patients. The index of two groups to observe mainly contained clinical curative effect, tumor markers and side effects. Results The disease control rates of experimental group is high up to 85.71%, significantly higher than that in control group （χ^2=5.143,P 〈0.05）; the progress free survival and overall survival of experimental group were longer than that in control group （t=6.689, 2.754,P 〈0.05 ）; The level of carcino-embryonic antigen （CEA）, cancer antigen 125 （CA125） and cytokeratin-19-fragment （CYFP, A21-1） of experimental group were 16.646, 15.125 and 16.428 （P 〈0.05）. The incidence of nausea and vomiting of experimental group was 40.48%, obvious lower than that in control group which was 76.19%. Other adverse reactions such as lethargy, constipation and fatigue etc were significantly higher than control group. Both groups showed similar level of white blood cells, platelet and hemoglobin and the incidence of peripheral nerve toxicity （P 〉0.05）. Conclusions Thalidomide combined with paclitaxel and cisplatin treatment helps to reduce the advanced non-smaU cell lung cancer serum tumor marker expression level, improve the clinical efficacy, but should prevent the side effects such as lethargy, constipation and fatigue etc.