术后辅助化疗后复发转移与初次诊断的Ⅳ期NSCLC一线化疗疗效分析

Analysis of first-line NSCLC chemotherapy in the phase Ⅳ patients with distant metastasis and first diagnosis after postoperative adjuvant chemotherapy

目的既往行根治性手术治疗的非小细胞肺癌(NSCLC)患者,即使进行了系统的术后辅助化疗,仍有很多不可避免的复发,甚至远处转移。同时,很多患者在初治时即为Ⅳ期。本文旨在探讨术后辅助化疗后远处转移的NSCLC患者一线化疗(First-line chemotherapy at recurrence post-adjuvant chemotherapy,FCRPC)与初治Ⅳ期NSCLC患者一线化疗(Initial first-line chemotherapy,IFC)的疗效对比。方法研究对象为603例远处转移非小细胞肺癌患者,其中73例为FCRPC组,530例为IFC组。采用倾向性评分匹配的统计学方法平衡两组间的临床特征,卡方检验进行两组间近期疗效对比。并采用Cox回归分析法和Kaplan-Meier分析法进行生存分析。结果在远处转移NSCLC患者中,FCRPC组的客观有效率(ORR)及疾病控制率(DCR)与IFC组无统计学差异(ORR率:FCRPC组27.4%vs.IFC组24.7%,P=0.851;DCR率:FCRPC组78.1%vs.IFC组65.6%,P=0.140)。FCRPC组与IFC组的中位无进展生存期(中位PFS:9.8个月vs.8.5个月,P=0.337)与中位总生存期(中位OS:20.0个月vs.14.4个月,P=0.087)均无统计学差异。结论术后辅助化疗后远处转移NSCLC与初治Ⅳ期NSCLC患者一线化疗的预后无统计学差异。

Objective In patients with non-small cell lung cancer(NSCLC)undergoing radical surgery,there were still many inevitable recurrences and distant metastases,even after systemic postoperative adjuvant chemotherapy.At the same time,many patients were in the stage IV at the time of initial treatment.The aims of this study were to investigate and compare the first-line chemotherapy(First-line Chemotherapy at Recurrence Post-adjuvant Chemotherapy,FCRPC)in NSCLC patients with distant metastasis after adjuvant chemotherapy with initial treatment at the phase IV of NSCLC patients with first-line chemotherapy(Initial First-line Chemotherapy,IFC).Methods A total of 603 patients with distant metastatic NSCLC were collected in this study.Among them,73 of them were FCRPC and 530 of them for IFC.Statistical methods for propensity score matching were used to balance the clinical features between FCRPC and IFC groups.Chi-square test was used to compare the short-term efficacy between FCRPC and IFC groups.Survival analysis was performed using regression analysis and Kaplan-Meier analysis.Results There was no significant difference in objective response rate(O RR)and disease control rate(DCR)between FCRPC and IFC groups in NSCLC patients with distant metastases(ORR rate:27.46%in the FCRPC group,24.7%in the PFC group,P=0.851 and DCR rate:78.1%in the FCRPC group,65.6%in the PFC group=0.140).There was also no significant difference in the median progression-free survival(9.8 months in the FCRPC group and 8.5 months in the PFC group,P=0.337)and median overall survival(20.0 months in the FCRPC group and 14.4 months in the PFC group,P=0.087).Conclusion There is no significant difference in the prognosis of first-line chemotherapy between NSCLC patients with distant metastases and with initial treatment at the stage I\^after adjuvant chemotherapy.