未明确病理诊断肺癌患者能否从抗癌治疗中获益(附245例病例疗效分析)

Can lung cancer patients with uncertain pathological diagnosis benefit from anti-cancer therapy? An efficacy analysis of 245 cases

目的:探讨未明确病理诊断肺癌患者能否行抗癌治疗。方法:回顾性分析天津医科大学肿瘤医院2011年1月至2015年12月收治的245例肺癌患者资料,记录不良反应及疗效。结果:非小细胞肺癌(non-small cell lung cancer,NSCLC)患者客观缓解率(objective response rate,ORR)和疾病控制率(disease control rate,DCR)分别为24.1%和82.1%,中位无进展生存期(median progres-sion free survivl,mPFS)和中位总生存期(median overall survival,mOS)分别为5.7和15.9个月,小细胞肺癌(small cell lung cancer,SCLC)患者ORR和DCR分别为48.0%和88.0%,中位PFS和总生存期(overall survival,OS)分别为5.8和16.5个月。Cox多因素回归分析示性别及血神经无特异性烯醇化酶(NSE)是PFS的独立影响因素。抗癌治疗后190例(77.6%)获得症状缓解,164例(66.9%)出现不良反应,因此中断治疗14例(5.7%)。结论:此类患者抗癌治疗后PFS短于文献报道的标准治疗后PFS,但近期症状缓解明显、生存质量改善,生存时间亦未缩短,不良反应发生率相近。

Objective： To discuss whether advanced-stage lung cancer patients with uncertain pathological diagnosis can be treated with anti-cancer therapy. Methods： A retrospective study was conducted of 245 lung cancer patients with uncertain pathological diagnosis who were treated in the Thoracic Oncology Department of Tianjin Medical University Cancer Institute and Hospital from January2011 to December 2015. For each patient, the therapeutic efficacy was evaluated at every two cycles, and toxicity was evaluated at every cycle, but only the most severe toxicities during the whole therapy were recorded. Results： The objective response rate（ORR） and disease control rate（DCR） were 24.1% and 82.1% in non-small cell lung cancer（NSCLC） patients and 48.0% and 88.0% in small cell lung cancer（SCLC） patients, respectively. The median progression-free survival（PFS） and median overall survival（m OS） were 5.7 and 15.9 months in NSCLC patients and 5.8 and 16.5 months in SCLC patients, respectively. Cox regression analysis indicated that sex and NSE were independent impact factors of PFS. One hundred and ninety patients showed symptomatic relief, and the remission rate was77.6%. One hundred and sixty-four patients developed adverse reactions, and the incidence of adverse reactions was 66.9%. Therapy was interrupted in 14 cases（5.7%）. Conclusions： In comparison with canonical treatment, although shorter PFS was found in the treatment by experienced oncologic doctors, the ＂instant symptom relief＂ was demonstrated, and the long-term survival was not shorter.In addition, the incidence rate of adverse reactions was similar.