不可手术局部晚期非小细胞肺癌放化疗安全性及疗效分析

Safety and Efficacy of Chemotherapy and Radiotherapy for the Treatment of Unresectable Locally Advanced Non-small Cell Lung Cancer

目的回顾性分析不可手术局部晚期非小细胞肺癌(LA-NSCLC)的放化疗疗效和安全性及影响其预后的因素。方法收集2010年1月至2015年12月于我科治疗的不可手术LA-NSCLC患者98例。其中单纯放疗组26例、同步放化疗组37例、序贯放化疗组35例,统计其无进展生存期(PFS)及总生存时间(OS)。采用Kaplan-Meier绘制生存曲线,并用log-rank/Breslow检验进行组间比较;单因素和COX多因素回归分析PFS和OS的独立预后因素。结果序贯放化疗组的中位PFS优于单纯放疗组,同步及序贯放化疗的中位OS均优于单纯放疗组(P<0.05)。较早的淋巴结分期、双药联合化疗及联合应用放化疗是PFS获益的独立影响因素;较早的淋巴结分期是OS获益的独立影响因素;总体治疗安全性良好,血液学毒性与化疗方案及患者的KPS评分相关(P<0.05)。结论对于LA-NSCLC,较早的淋巴结分期、双药联合化疗及联合应用放化疗治疗是PFS获益的独立影响因素;较早的淋巴结分期是OS获益的独立影响因素。总体治疗安全性良好,但联合化疗和较低的KPS评分会增加血液学毒性。

Objective The aim of this study was to retrospectively review the efficacy and safety of treatment for unresectable locally advanced non-small cell lung cancer （LA-NSCLC）. Methods A total of 98 patients treated in our hospital between January 2010 and December 2015 were enrolled in this study. Patients were divided into three groups ：the thoracic radiotherapy （TRT） alone, concurren! chemoradiotherapy, and sequential chemoradiotherapy groups. The progression-free survival （PFS） and overall survival （OS） were analyzed via the Kaplan-Meier method, and compared with the log-rank/Breslow test. The prognostic factors were analyzed using the Kaplan-Meier and Cox multivariate proportional hazards models. Results The median PFS in the concurrent therapy group was longer than that in the TRT alone group （P 〈 0.05）. The median OS was improved in patients treated with concurrent or sequential therapy than in the TRT alone group （P 〈 0.05）. N stage, chemotherapy regimens,and radiotherapy modalities were indel^ndent prognostic factors of PFS in all patients （P 〈 0.05 ）. Similarly, N stage was an independent prognostic factor of OS in all patients （P 〈 0.05）. Overall, the treatment was deemed safe. The occurrence of hematotoxicity related to Karnofsky performance score （KPS） and chemotherapy regimens （P 〈 0.05）. Conclusion Patients with a lower N stage who received cisplatin-based double chemoradiotherapy demonstrated improved survival rates. Survival was significantly improved in LA-NSCLC patients treated with concurrent or sequential therapies compared with TRT alone. Overall, the treatment is safe. KPS and chemotherapy combination regimens may increase the occurrence of hematotoxicity.