卡培他滨节拍化疗与常规化疗对老年转移性乳腺癌患者维持治疗效果的比较

Efficacy comparison of capecitabine metronomic chemotherapy and conventional chemotherapy in the maintenance of elderly patients with metastatic breast cancer

目的 探讨卡培他滨节拍化疗在老年转移性乳腺癌维持治疗中的临床效果.方法 选择2014年4月至2017年4月江苏盛泽医院普外科收治的老年转移性乳腺癌患者56例,将其按照随机数字表法分为节拍化疗组和常规化疗组,每组28例.节拍化疗组给予小剂量卡培他滨500mg,2次/d,持续口服;常规化疗组给予卡培他滨1250mg,2次/d,连续14d,停药7d,21d为1个疗程,2个疗程后进行临床疗效、不良反应和生活质量评价.结果 节拍化疗组患者的有效率（RR）、控制率（DCR）与常规化疗组相比（39.3%比42.8%,89.3%比85.7%）,差异均无统计学意义（χ2值分别为0.526、0.758,均P〉0.05）.节拍化疗组整体中位无进展生存（PFS）时间为5.8个月（95% CI 3.23~7.44,P=0.764）,中位总生存（OS）时间为7.9个月（95% CI 4.15~7.95,P=0.519）;常规化疗组中位PFS时间为7.2个月（95% CI 3.32~6.43,P=0.835）,中位OS时间为11.3个月（95% CI 4.08~7.37,P=0.463）,两组比较差异无统计学意义（均P〉0.05）.常规化疗组手足综合征、骨髓抑制及消化道反应发生率均高于节拍化疗组,两组比较差异均有统计学意义（均P〈0.05）,节拍化疗组未见Ⅲ、Ⅳ级不良反应.节拍化疗组生命质量的总提升率较常规剂量组高（92.9%比78.8%）,差异有统计学意义（χ2=7.629,P〈0.05）.结论 卡培他滨节拍化疗在老年转移性乳腺癌患者维持治疗中的临床疗效与常规剂量维持治疗相当,但可减轻患者的不良反应,提高患者的生命质量.

Objective To investigate the clinical efficacy of capecitabine metronomic chemotherapy in the maintenance of elderly patients with metastatic breast cancer. Methods Fifty-six patients with metastatic breast cancer treated in Jiangsu Shengze Hospital from April 2014 to April 2017 were randomly divided into two groups according to random number table method： metronomic chemotherapy group （n = 28） and conventional chemotherapy group （n = 28）. The patients in the metronomic chemotherapy group were treated with capecitabine 500 mg, 2 times/d and continuous oral administration. The conventional chemotherapy group received capecitabine 1 250 mg, 2 times/d for 14 days, rested for 7 days, 21 days was a course of treatment.After two courses,the clinical efficacy,toxicity and quality of life were evaluated. Results There were no significant differences in RR and DCR between the metronomic chemotherapy group and conventional chemotherapy group （RR： 39.3 % vs. 42.8 %, DCR： 89.3 % vs. 85.7 %, both P 〉 0.05）. The median progression-free survival （PFS） time in the metronomic chemotherapy group was 5.8 months （95 % CI 3.23-7.44, P= 0.764） and median overall survival （OS） time was 7.9 months （95 % CI 4.15-7.95, P=0.519）. The median PFS time in the conventional chemotherapy group was 7.2 months （95 % CI 3.32-6.33, P=0.835）, median OS time was 10.3 months （95 % CI 4.08-7.37, P=0.463）. There was no significant difference between the two groups （both P〉 0.05）. The incidences of hand-foot syndrome, myelosuppression and digestive tract reaction in conventional chemotherapy group were higher than those in metronomic chemotherapy group, there were significant differences between the two groups （all P 〈 0.05）. No Ⅲ-Ⅳ level adverse reactions were found in the metronomic chemotherapy group. The overall rate of improvement of the quality of life in the metronomic chemotherapy group was significantly higher than that in the conventional chemotherapy group （92.9 % vs. 78.8 %, χ 2= 7.629, P 〈 0.05）. Conclusion The clinical efficacy of capecitabine metronomic chemotherapy in the maintenance of elderly patients with metastatic breast cancer is similar to conventional dose maintenance therapy,but it can not only reduce the side effects, but also improve the quality of life of patients.