依托泊苷维持治疗小细胞肺癌的疗效及安全性研究

Efficacy and safety of etoposide for maintenance therapy of small-cell lung cancer

目的小细胞肺癌一线治疗缓解率高但远期疗效差,短期内出现复发进展,且二线治疗敏感性低。文中旨在探讨依托泊苷胶囊维持治疗对广泛期小细胞肺癌生存期的影响。方法回顾性分析2014年1月至2015年9月郑州大学附属肿瘤医院呼吸内科收治的82例广泛期小细胞肺癌患者临床资料。将患者分为依托泊苷组(n=37,一线化疗后口服依托泊苷维持治疗,定期复查)和对照组(n=45,一线治疗完成后不服用任何药物,定期复查)。对比2组的无进展生存期(PFS)、总生存时间(OS)和不良反应。结果依托泊苷组中位PFS较对照组延长(3.5个月vs 2.8个月,P=0.012)。依托泊苷组及对照组的1年、2年生存率(59.5%、12.6%)较对照组(43.9%、4.9%)明显升高(P<0.05)。Cox比例风险模型分析显示一线治疗疗效(RR=2.036,95%CI:1.127~3.676)及BMI指数≥25(RR=0.598,95%CI:0.359~0.997)、<18(RR=4.607,95%CI:2.203~9.631)是影响患者生存的危险因素(P<0.05)。2组各种不良反应发生率差异无统计学意义(P>0.05)。结论广泛期小细胞肺癌患者一线治疗后口服依托泊苷胶囊可以延长患者的无进展生存期,安全性好,是一种可行的维持治疗方案。

Objective Small cell lung cancer（SCLC） is generally sensitive to first-line therapy,but it has poor long-term efficacy,short-term recurrence and low sensitivity of second-line therapy.The study aimed to investigate the impact of etoposide capsule for the maintenance therapy of extensive stage SCLC.Methods A retrospective analysis was made on 82 patients with extensive SCLC treated in Tumor Hospital affiliated to Zhengzhou University from January 2014 to September 2015.The patients were divided into etoposide group（n = 45,oral etoposide treatment after first-line chemotherapy） and control group（n = 45,regular review after first-line therapy）.Comparison was conducted in progression-free survival（PFS）,total survival time（OS） and adverse reactions between two groups.Results The median PFS of etoposide group was higher than that of control group（3.5 months vs 2.8 months,P = 0.012）.The one-year and two-year survival rates of etoposide group were significantly higher than those of control group（59.5% vs 43.9%,12.6% vs 4.9%,P 0.05）.The analysis of Cox proportional hazard model showed first-line therapy（RR = 2.036,95%CI：1.127 ~ 3.676）and BMI ≥ 25（RR = 0.598,95% CI：0.359 ~ 0.997）, 18（RR =4.607,95%CI：2.203 ~ 9.631） were the risk factors for survival.No significant difference was found as to the risk of adverse effects between two groups.Conclusion Maintenance therapy with oral etoposide may improve progression-free-survival（PFS） in patients with extensive SCLC,which is safe and practical for maintenance therapy.