36例体力状况评分≥2分的晚期非小细胞肺癌患者的临床分析

Clinical analysis of 36 cases of advanced non-small cell lung cancer （NSCLC） with performance status （PS） scores between 2 and 4

目的 分析体力状况（PS）评分≥2分的晚期非小细胞肺癌（NSCLC）患者的临床特点,提高其诊治水平.方法 回顾性分析36例以低氧血症为主要表现的晚期NSCLC患者的临床特点、低氧血症的原因、并发症、呼吸支持情况、抗肿瘤治疗方案、肿瘤进展和二次活检情况.疗效依据实体瘤的疗效评价标准分为完全缓解（CR）、部分缓解（PR）、稳定（SD）和进展（PD）.结果 36例晚期NSCLC患者均有低氧血症,其中31例（86.1%）患者合并其他基础疾病,20例（55.6%）患者应用无创呼吸机辅助呼吸支持.有28例（77.8%）患者应用广谱抗生素治疗,其中22例（78.6%）患者在抗感染治疗后肺部渗出影减轻.有15例患者行床边纤维支气管镜吸痰,其中2例因大气道阻塞而置放气道支架,4例行胸腔引流术,4例行抗凝治疗,1例经溶栓处理.在非肿瘤治疗前后,36例晚期NSCLC患者的PS评分分别为（3.4±0.5）分和（2.5±0.7）分,脉搏血氧饱和度（SPO2）分别为（89.0±5.2）% 和（95.0±3.5）%.在一线抗肿瘤治疗中,口服靶向药9例,采用含培美曲塞＋贝伐单抗或卡铂方案13例,采用紫杉醇＋卡铂方案8例,采用吉西他滨＋卡铂方案4例,采用多西他赛＋吉西他滨方案2例.首次评估时,CR 1例,PR 23例,SD 4例,PD 8例,临床获益率为66.7%,疾病控制率为77.8%.在治疗期间,有22例患者出现 PD,其中行二次活检8例,二代测序6例,检测率为63.6%.36例晚期NSCLC患者中,生存10例（27.8%）,无进展生存时间（PFS）为（10.0±6.5）个月.结论 对于PS≥2分的NSCLC患者,应在控制原发肿瘤的同时,积极治疗并发症,并在最短时间内选择最佳的治疗方案,控制病情,改善PS评分,为抗肿瘤治疗提供机会.同时要重视肿瘤的异质性和二次活检.

Objective To analyze the treatment of advanced non-small cell lung cancer（NSCLC） with performance status（PS）scores between 2 and 4, in order to improve the diagnosis and treatment of these patients. Methods A total of 36 patients with advanced NSCLC with hypoxemia were reviewed. The clinical data of disease characteristics, etiology, complications, manifestation, therapy, progression, and secondary biopsy were collected. The clinical efficacy was graded according to the Response Evaluation Criteria In Solid Tumors（RECIST）： complete response（CR）, partial response（PR）, stable disease （SD）and disease progression（PD）. Results All patients had hypoxemia,of whom 86.1%（31 patients） had complications and 55.6%（20 patients）had noninvasive ventilator for respiratory support. 77.8%（28 cases）received broad-spectrum antibiotic treatment, and 78.6% of them got lung osmotic relief after the anti-infection treatment. 15 cases received bedside fiberoptic bronchoscopy suction,of whom two cases were treated with airway stent deposition due to airway obstruction, four cases with thoracic drainage, four cases with anticoagulation,and one with thrombolytic therapy. After these supportive treatment, the PS score of these patients decreased from 3.4± 0.5 to 2.5± 0.7, while SPO2improved from（89.0± 5.2）% to（95.0 ± 3.5）%. As first-ling anti-cancer treatment, nine patients were administrated with targeted medicine orally, 13 patients with a combined chemotherapy of pemetrexed plus bevacizumab or carboplatin, eight patients with paclitaxel plus carboplatin, four patients with gemcitabine plus carboplatin, and two patients with docetaxel plus gemcitabine.In the first response evaluation,there were one case of CR,23 cases of PR,four cases of SD, and eight cases of PD, with a clinical benefit rate of 66.7% and a disease control rate of 77.8%. A total of 22 patients experienced disease progression, of whom eight cases had a secondary biopsy and six cases had gene sequencing. Of these 36 patients, 10（27.8%）patients survived at the last follow-up,with a progression-free survival of（10.0 ± 6.5）months. Conclusion Besides prompt anti-cancer treatment and best supportive treatment should be incorporated to improve PS and improve outcome.