不同化疗药物治疗小细胞肺癌对患者预后及肿瘤标志物水平的影响

Effects of different chemotherapies on prognosis and tumor markers in patients with small cell lung cancer

目的探讨两种化疗方案治疗小细胞肺癌的效果差异及安全性。方法选取广西壮族自治区柳州市人民医院2013年3月至2016年3月收治的98例广泛期小细胞肺癌患者,采用随机数字表法将患者分为两组,其中49例患者采用洛铂+依托泊苷治疗(EL组),另外49例采用顺铂+依托泊苷治疗(EP组),观察两组患者近期疗效、2年生存率及不良反应,对比两组患者治疗前后的血清胃泌素释放肽前体(ProGRP)、神经元特异性烯醇化酶(NSE)、Ki-67、血管内皮细胞生长因子(VEGF)水平。结果EL组和EP组患者的有效率分别为48.98%(24/49)和40.82%(20/49),差异无统计学意义(χ^2=0.660,P=0.417)。EL组与EP组患者2年生存率分别为17.07%、11.11%,EL组患者的中位生存时间为17.00个月,EP组为15.00个月,差异无统计学意义(χ^2=1.094,P=0.228)。化疗前,EL组和EP组患者血清ProGRP分别为(978.4±225.7)ng/L、(940.2±237.1)ng/L,NSE分别为(43.9±10.3)ng/ml、(41.7±11.6)ng/ml,Ki-67分别为(287.5±55.3)pg/ml、(279.8±62.6)pg/ml,VEGF分别为(566.8±109.4)pg/ml、(538.1±144.0)pg/ml,组间比较差异均无统计学意义(t=0.817,P=0.416;t=0.993,P=0.323;t=0.645,P=0.520;t=1.111,P=0.269);化疗后,两组患者血清ProGRP分别为(167.3±68.5)ng/L、(180.6±62.1)ng/L,NSE分别为(17.5±4.8)ng/ml、(19.0±5.3)ng/ml,Ki-67分别为(98.0±18.6)pg/ml、(101.4±20.8)pg/ml,VEGF分别为(430.4±95.8)pg/ml、(442.8±91.0)pg/ml,组间比较差异均无统计学意义(t=-1.007,P=0.316;t=-1.468,P=0.145;t=-0.853,P=0.396;t=-0.657,P=0.513);EL组和EP组患者化疗后的血清ProGRP、NSE、Ki-67、VEGF均较化疗前显著降低,差异均有统计学意义(t=24.072,P<0.001;t=21.694,P<0.001;t=16.263,P<0.001;t=12.459,P<0.001;t=22.736,P<0.001;t=18.931,P<0.001;t=6.566,P<0.001;t=3.916,P<0.001)。化疗过程中,EL组患者≥2级腹泻和骨髓抑制的发生率[26.53%(13/49)和61.22%(30/49)]均低于EP组患者[48.98%(24/49)和81.63%(40/49)],差异均具有统计学意义(χ^2=5.254,P=0.022;χ^2=5.000,P=0.025)。结论洛铂+依托泊苷治疗小细胞肺癌较顺铂+依托泊苷疗效相当,不良反应更轻。

Objective To explore the effect and safety of two chemotherapy regimens in the treatment of small cell lung cancer.Methods Ninety-eight patients with extensive small cell lung cancer admitted to Liuzhou People′s Hospital of Guangxi Zhuang Autonomous Region from March 2013 to March 2016 were randomly divided into two groups by random number table method,49 of whom were treated with lobaplatin+etoposide(EL group),and another 49 cases were treated with cisplatin+etoposide(EP group).The short-term efficacy,2-year survival rate and adverse reactions of the two groups were observed.The serum levels of gastrin-releasing peptide precursor(ProGRP),neuron-specific enolase(NSE),Ki-67,vascular endothelial growth factor(VEGF)were compared between the two groups before and after treatment.Results The effective rates of the EL group and the EP group were 48.98%(24/49)and 40.82%(20/49)respectively,and the difference between the two groups was not statistically significant(χ^2=0.660,P=0.417).The 2-year survival rates of patients in the EL group and the EP group were 17.07%and 11.11%respectively.The median survival time of the EL group was 17.00 months,and that of the EP group was 15.00 months.There was no significant difference between the two groups(χ^2=1.094,P=0.228).The serum level of ProGRP was(978.4±225.7)ng/L and(940.2±237.1)ng/L,NSE was(43.9±10.3)ng/ml and(41.7±11.6)ng/ml,Ki-67 was(287.5±55.3)pg/ml and(279.8±62.6)pg/ml,and VEGF was(566.8±109.4)pg/ml and(538.1±144.0)pg/ml in the EL and EP group before chemotherapy respectively,and there were no significant differences between the two groups(t=0.817,P=0.416;t=0.993,P=0.323;t=0.645,P=0.520;t=1.111,P=0.269).The serum level of ProGRP was(167.3±68.5)ng/L and(180.6±62.1)ng/L,NSE was(17.5±4.8)ng/ml,(19.0±5.3)ng/ml,Ki-67 was(98.0±18.6)pg/ml and(101.4±20.8)pg/ml,VEGF was(430.4±95.8)pg/ml and(442.8±91.0)pg/ml in the EL and EP group after chemotherapy,and there was no significant difference between the two groups(t=-1.007,P=0.316;t=-1.468,P=0.145;t=-0.853,P=0.396;t=-0.657,P=0.513).The serum levels of ProGRP,NSE,Ki-67 and VEGF in EL group and EP group were significantly lower than those before chemotherapy(t=24.072,P<0.001;t=21.694,P<0.001;t=16.263,P<0.001;t=12.459,P<0.001;t=22.736,P<0.001;t=18.931,P<0.001;t=6.566,P<0.001;t=3.916,P<0.001).During chemotherapy,the incidences of diarrhea and myelosuppression(≥grade 2)in the EL group[26.53%(13/49)and 61.22%(30/49)]were lower than those in the EP group[48.98%(24/49)and 81.63%(40/49)],and the differences were statistically significant(χ^2=5.254,P=0.022;χ^2=5.000,P=0.025).Conclusion Lobaplatin+etoposide is less toxic than cisplatin+etoposide in the treatment of small cell lung cancer,and adverse reactions of its is relatively slighter.