射频消融联合化疗对中晚期非小细胞肺癌患者的治疗效果研究

Therapeutic efficacy of radiofrequency ablation combined with chemotherapy for advanced nonsmall cell lung cancer

目的探讨射频消融联合化疗对中晚期非小细胞肺癌(NSCLC)患者的治疗效果。方法选取2014年8月至2017年2月间广东省佛山市第一人民医院收治的80例中晚期NSCLC患者,采用随机数字表法分为观察组和对照组,每组40例。对照组患者采用吉西他滨+顺铂联合化疗,观察组患者先采用射频消融治疗,再进行吉西他滨+顺铂联合化疗。比较两组患者近期疗效和不良反应发生率。绘制K-M时间生存曲线,采用Log-Rank检验比较两组患者的中位生存时间。结果治疗期间,两组患者出现咯血5例,发热7例,胸痛9例,胃肠道反应50例,脱发34例。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。治疗后1个月,两组患者CT值均较治疗前降低,且观察组患者CT值下降更为显著,差异均有统计学意义(均P<0.05)。治疗后1个月,观察组患者疾病控制率(DCR)为90.0%,大于对照组的72.5%,差异有统计学意义(P<0.05)。观察组患者肿瘤3~4.9cm、5~6.9cm和7~9cm的DCR分别为96.0%、81.2%和75.0%,与对照组比较,差异均有统计学意义(均P<0.05)。末次随访时,观察组患者死亡26例,存活14例;对照组患者死亡33例,存活7例。两组患者存活率分别为35.0%和17.5%,差异无统计学意义(P>0.05)。观察组和对照组患者中位生存时间分别为440d和254d,经Log-Rank检验显示,差异有统计学意义(P<0.05)。结论射频消融联合化疗治疗中晚期非小细胞肺癌患者的临床疗效确切,可明显提高疾病控制率,延长生存时间,不增加不良反应。

Objective To investigate the therapeutic efficacy of radiofrequency ablation combined with chemotherapy for advanced non-small cell lung cancer （ NSCLC ）. Methods A total of 80 patients with advanced NSCLC treated at The First People＇s Hospital of Foshan from August 2014 to February 2017 were selected. They were randomly divided into an observation group and a control group by the random number table method, with 40 patients in each group. Patients in the observation group were treated with ra- diofrequency ablation combined with gemcitabine and cisplatin chemotherapy and patients in the control group were treated with gemcitabine and cisplatin chemotherapy. The short-term efficacy and incidence of adverse reactions were compared between the two groups. The K-M time survival curve was drawn and the me- dian survival time was compared between the two groups by Log-Rank test. Results Hemoptysis occurred in 5 patients, fever in 7 patients, chest pain in 9 patients, gastrointestinal reaction in 50 patients and alopecia in 34 patients during the treatment. There was no significant difference in the incidence of adverse reactions be- tween the two groups （P 〉 0. 05 ）. At 1 month after the treatment, the CT values significantly decreased in the two groups with the decreation more significant in the observation group than in the control group （ all P 〈 0. 05）. At 1 month after the treatment, the disease control rate （DCR） was 90. 0% for the observation group which was significantly higher than72. 5% of the control group （P 〈0. 05）. Compared with the control group, the DCR were 96. 0%, 81.2% and 75.0%, respectively in patients with tumor size of 3 to 4. 9cm, 5 to 6. 9cm and 7 to 9cm （all P 〈0. 05）. At the last follow-up, 26 patients died and 14 patients were still alive in the observation group compared with 33 patients and 7 patients in the control group and the survival rate was 35.0% and 17.5% respectively for the observation group and the control group （P 〉 0. 05）. The medi- an survival time was 440 dand 254 d for the observation group and the control group respectively and Log- Rank test showed that the difference was significant （ P 〈 0. 05 ）. Conclusion Radiofrequency ablation combined with chemotherapy is effective in the treatment of advanced non-small cell lung cancer. It can sig- nificantly improve the disease control rate, prolong the survival time, without increasing the adverse reac- tions.