紫杉醇脂质体或吉西他滨联合顺铂治疗老年人晚期肺鳞状细胞癌效果比较

Efficacy comparison of paclitaxel liposome or gemcitabine combined with cisplatin for treatment of elderly patients with advanced lung squamous cell carcinoma

目的 比较紫杉醇脂质体或吉西他滨联合顺铂治疗老年人晚期肺鳞状细胞癌的临床效果和安全性.方法 回顾性分析昆山市第一人民医院2012年1月至2016年10月收治的采用紫杉醇脂质体或吉西他滨联合顺铂化疗的52例老年晚期肺鳞状细胞癌患者临床资料.紫杉醇脂质体组24例,吉西他滨组28例.所有患者至少接受2个周期以上化疗,化疗周期数2-6个.每2个周期复查CT,根据美国国家癌症研究所实体瘤疗效评价标准（NCI RECIST）和常见不良事件评价标准（NCI CTCAE）对两组疗效和不良反应进行评估.结果 紫杉醇脂质体组与吉西他滨组的客观反应率（ORR）及疾病控制率（DCR）差异均无统计学意义[ORR：29.2%（7/24）比32.1%（9/28）,χ^2=0.054,P=0.817;DCR：70.8%（17/24）比71.4%（20/28）,χ^2=0.002,P=0.962].吉西他滨组中位无进展生存时间略长于紫杉醇脂质体组,差异无统计学意义（5.7个月比5.4个月,χ^2=0.466,P=0.495）;吉西他滨组1年生存率略高于紫杉醇脂质体组,差异无统计学意义（37.0%比34.8%,χ^2=0.027,P=0.869）.但紫杉醇脂质体组的血液学不良反应低于吉西他滨组,差异有统计学意义（P〈0.05）.结论 紫杉醇脂质体联合顺铂治疗老年人晚期肺鳞状细胞癌的疗效不劣于吉西他滨联合顺铂,且不良反应较小,可推荐作为老年晚期肺鳞状细胞癌患者的一线化疗方案.

Objective To evaluate the clinical effects and safety of paclitaxel liposome or gemcitabine combined with cisplatin in elderly patients with advanced lung squamous cell cancer. Methods A total of 52 elderly patients with advanced lung squamous cell cancer in Kunshan First People＆#39;s Hospital from January 2012 to October 2016 who received paclitaxel liposome with cisplatin （n=24） or gemcitabine with cisplatin（n = 28） were analyzed retrospectively. The patients received at least 2 cycles of chemotherapy, 2-6 cycles in total. CT was rechecked every 2 cycles. The clinical effects and adverse reactions were evaluated by National Cancer Institute Response Evaluation Criteria in Solid Tumors （NCI RECIST） and NCI Common Terminology Criteria for Adverse Events （NCI CTCAE）. Results The objective response rate （ORR） and the disease control rate（DCR）in paclitaxel liposome group and in gemcitabine group had a lot in common [ORR：29.2 %（7/24）vs.32.1 %（9/28）,χ^2=0.054,P =0.817;DCR：70.8 %（17/24）vs.71.4 %（20/28）,χ^2=0.002,P =0.962]. The median progression-free survival（PFS） time in gemcitabine group was longer than that in paclitaxel liposome group （5.7 months vs. 5.4 months, χ^2= 0.466, P = 0.495）. One-year survival rate in gemcitabine group （37.0 %） was higher than that in paclitaxel liposome group （34.8 %） and there was no statistically significant difference （χ 2= 0.027, P = 0.869）. However, hematologic adverse reactions in paclitaxel liposome group were lower than those in gemcitabine group （P〈 0.05）. Conclusion The effect of paclitaxel liposomes combined with cisplatin for treatment of elderly patients with advanced lung squamous cell carcinoma is not inferior to gemcitabine combined with cisplatin, which has less adverse reactions and may be recommended as the first-line chemotherapy for the patients.