合并症对老年肺癌患者化疗耐受性及生存期的影响

Influence of comorbidities on chemotherapy-related toxicity and survival in elderly patients with lung cancer

目的:探讨合并症对老年肺癌患者化疗耐受性及生存期的影响。方法:回顾分析51例65岁以上老年肺癌患者的临床资料。采用老年疾病累计评定量表(CIRS-G)评估合并症,采用通用不良事件术语标准(CTCAE v3.0)评估化疗不良反应,分析患者合并症与化疗严重不良反应及生存期的相关性。结果:伴严重合并症的老年肺癌患者较不伴者发生3～4级肺部感染、皮疹等不良反应率显著增多(P=0.001),化疗未完成率显著上升(69%vs 32%,P=0.040),因不能耐受化疗不良反应而改变化疗方案的发生率也显著上升(69%vs 26%,P=0.021)。合并症指数较高和较低组患者发生3～4级化疗不良反应及化疗完成率、化疗方案改变差异均无统计学意义(P=0.827、0.174、0.074)。年龄≥75岁、肺癌分期Ⅲ～Ⅳ期、化疗方案改变是肺癌患者无进展生存期的独立预后因素;严重合并症与合并症指数较高对无进展生存期无显著影响(P=0.143、0.868),伴有严重合并症的患者无进展生存期有缩短趋势。结论:严重合并症可使老年肺癌患者化疗耐受性下降,化疗未完成率和化疗方案改变率增加,从而影响无进展生存期;严重合并症评分评估化疗耐受性和无进展生存期比合并症指数敏感性高,相关结论仍需进一步大样本研究证实。

Objective：To investigate the influence of comorbidities on tolerance to chemotherapy and patients＇ survival in elderly patients with lung cancer.Methods：Fifty-one elderly patients（over 65 years old）with lung cancer were enrolled in this retrospective study,and their clinical characteristics were analyzed.Comorbidities were assessed using the Cumulative Illness Rating Scale for Geriatrics（CIRS-G）.Chemotherapy-realted toxicity was graded using the common terminology criteria for adverse events（CTCAE v3.0）.The correlation between comorbidities and chemotherapy-related serious adverse events and survival was analyzed.Results：The patients with severe comorbidities were more likely to have grade 3-4 lung infections and skin rashes（P =0.001）,incomplete cycles（69% vs 32%,P =0.040）,and changed chemotherapy regimens due to chemotherapy-related toxicities（69% vs 26%,P=0.021）.The patients with high severity index had similar grade 3-4 chemotherapy-related toxicities as other patients,similar frequency of completing all cycles and chemotherapy regimens changing（P=0.827,P=0.174,and P=0.074）.Age≥75 years old,stage Ⅲ-Ⅳ or chemotherapy regimens changing were independent predictors for progression-free survival in patients with lung cancer.There were no significant differences in progression-free survival when comparing patients with or without severe comorbidities（P=0.143）and patients with higher severity index versus those with the lower（P=0.868）.But there was a tendency that the patients with severe comorbidity would have poorer progression-free survival.Conclusions：The patients with severe comorbidities had poorer tolerance to chemotherapy,were more likely to have incomplete cycles and changed chemotherapy regimens,and therefore might have poorer progression-free survival.The score of severe comorbidity was more sensitive than the severity index.However,these conclusions need to be further confirmed by trials with larger sample size.