静脉化疗联合^(125)I放射性粒子植入治疗中晚期非小细胞肺癌的疗效评价

Efficacy evaluation of intravenous chemotherapy combined with ^(125)I seed implantation in treating advanced non-small cell lung cancer

目的评价静脉化疗联合^(125)I粒子植入治疗中晚期非小细胞肺癌(NSCLC)的疗效。方法回顾性分析85例NSCLC患者,根据治疗方法不同分为两组:联合组42例,行静脉化疗联合^(125)I粒子植入治疗;对照组43例,行单纯静脉化疗。比较两组治疗后血清肿瘤标志物、血常规、患者术后生存质量、并发症、局部有效率及远期生存率差异。结果联合组术后3个月总有效率为71.4%,明显高于对照组39.5%(P<0.05),联合组术后3个月鳞癌有效率为64.7%,腺癌有效率为76.0%;对照组静脉化疗后3个月鳞癌有效率为41.2%,腺癌有效率为38.5%。联合组患者中位生存时间为14.7个月,对照组为7.6个月,联合组1、2年累积生存率分别为59.2%、28.6%,对照组为34.6%、14.0%,联合组生存率明显优于对照组(χ~2=5.503,P=0.019)。Ⅲb期联合组患者中位生存期15.9个月,对照组为8.3个月,联合组1、2年累积生存率为68.0%、36.0%,对照组1、2年累积生存率为38.5%、15.4%,Ⅲb期联合组生存率高于对照组(χ~2=5.934,P=0.015)。Ⅳ期联合组中位生存期为8.6个月,对照组为6.3个月,联合组1、2年累积生存率为45.8%、17.6%,对照组1、2年累积生存率为22.1%、11.8%,Ⅳ期联合组2年累积生存率与对照组差异无统计学意义(χ~2=1.446,P=0.229)。联合组术后1个月CEA下降水平明显高于对照组(P<0.05)。联合组治疗后血常规与术前比较,差异均无统计学意义(P>0.05)。结论静脉化疗联合^(125)I放射性粒子治疗中晚期NSCLC是安全、有效的介入治疗方法。

Objective To evaluate the efficacy of intravenous chemotherapy combined with 125I seed implantation in the treatment of advanced non-small cell lung cancer （NSCLC）. Methods The clinical data of a total of 85 NSCLC patients were retrospectively analyzed. According to the therapeutic method, the patients were divided into the combination group （n=42, receiving intravenous chemotherapy combined with CT-guided 125I seed implantation） and the control group （n=43, receiving simple intravenous chemotherapy）. The postoperative serum tumor markers, routine blood testing, postoperative quality of life of patient, complications, local effective rate, and long- term survival rate were compared between the two groups. Results The postoperative 3- month total effective rate in the combination group was 71.4%, which was significantly higher than that of 39.5% in the control group （P〈0.05）. Three months after the treatment, the effective rates of squamous cell carcinoma and adenocarcinoma in the combination group were 64.7% and 76.0% respectively, which were 41.2% and 38.5% respectively in the control group. The median survival time was 14.7 months in the combination group and 7.6 months in the control group. The one-year and 2-year cumulative survival rates in the combination group were 59.2% and 28.6% respectively, which were 34.6% and 14.0% respectively in the control group; the survival rate of the combination group was significantly higher than that of the control group （χ2=5.503, P=-0.019）. The median survival time of the patients with stage Ⅲb was 15.9 months in the combination group and was 8.3 months in the control group; the one-year and 2- year cumulative survival rates in the combination group were 68.0% and 36.0% respectively, which were 38.5% and 15.4% respectively in the control group; the stage Ⅲb survival rate of the combination group was significantly higher than that of the control group （χ2=5.934, P=0.015）. The median survival time of the patients with stage Ⅳ was 8.6 months in the combination group and was 6.3 months in the control group; the one-year and 2-year cumulative survival rates in the combination group were 45.8% and 17.6% respectively, which were 22.1% and 11.8% in the control group. The 2-year cumulative survival rate in the combination group had statistical difference with that in the control group 0（2=1.446, P=0.229）. One month after the treatment, the declining level of CEA in the combination group was significantly larger than that in the control group （P〈0.05）. The results of postoperative blood routine testing in the combination group showed no statistically significant changes when compared with the preoperative data （P〉0.05）. Conclusion For advanced NSCLC, intravenous chemotherapy combined 125I seed implantation is a safe and effective interventional treatment.