含卡铂的两种化疗方案对老年晚期肺腺癌合并慢性肾功能不全代偿期患者的应用

Comparison of therapeutic efficacy of two chemotherapy regimens containing carboplatin in patients with advanced lung adenocarcinoma complicated with chronic renal insufficiency

【目的】观察卡铂联合多西他赛或吉西他滨治疗老年晚期肺腺癌合并慢性肾功能不全(代偿期)患者的临床疗效、毒性反应和肾功能的影响。【方法】选取于2015年10月至2017年1月在胸心血管外科收治的老年晚期肺腺癌患者84例,化疗前处于慢性肾功能不全代偿期,随机分为DC组(多西他赛+卡铂)和GC组(吉西他滨+卡铂),各42例。DC组:多西他赛75 mg/m^2第1天,卡铂AUC5第1天;GC组:吉西他滨1000 mg/m^2第1天和第8天,卡铂AUC5第1天。21 d为1个周期,至少完成2个周期。比较两组患者的临床疗效、化疗期间的毒性反应发生情况以及化疗前与化疗2个周期后肾小球滤过率的变化,血清中肌酐、尿素、β2微球蛋白(β2 microglobulin,β2-MG)和胱抑素C水平。【结果】DC组和GC组完成2个周期化疗纳入可评价近期疗效的患者分别为38例和36例。DC组总有效率为39.5%,GC组总有效率为44.4%,两组差异无统计学意义(P>0.05)。GC组患者KPS积分改善≥20分人数比例显著高于DC组(P<0.05)。GC组发生血小板减少率显著低于DC组(P<0.05),GC组腹泻和乏力的发生率均显著低于DC组(P<0.05)。两组其余不良反应发生率无统计学差异(P>0.05)。DC组经过2个周期化疗后肾小球滤过率显著下降(P<0.05);GC组治疗后肾小球滤过率较治疗前略有下降,但差异无统计学意义(P>0.05);DC组化疗后肾小球滤过率下降程度高于GC组(P<0.05)。经过2个周期化疗后,GC组患者其血清肌酐、尿素、β2-MG和胱抑素C水平均显著优于DC组患者(P<0.05)。【结论】DC和GC方案治疗老年晚期肺腺癌合并慢性肾功能不全(代偿期)患者的临床疗效相近,但GC方案的肾毒性更小,对肾功能有较好的保护作用。

【Objective】To observe the clinical efficacy,toxicity and renal function of carboplatin combined with docetaxel or gemcitabine in elderly patients with advanced lung adenocarcinoma complicated with chronic renal insufficiency(decompensated).【Methods】A total of 84 patients with advanced lung adenocarcinoma admitted to our hospital from October 2015 to January 2017 were randomly divided into DC group(docetaxel+Carboplatin)and GC group(gemcitabine+carboplatin),42 patients in each group.DC group:docetaxel 75 mg/m^2,d1+carboplatin AUC5,d1;GC group:gemcitabine 1000 mg/m^2,d1,8+carboplatin AUC5,d1,21 days for one cycle,at least two cycles.The clinical efficacy of the two groups was compared.The occurrence of toxic reactions during chemotherapy and changes of glomerular filtration rate,serum levels of creatinine,urea,β2 microglobulin(β2-MG)and cystatin C at 1 month before and after chemotherapy were also compared.【Results】The patients in the DC group and GC group treated with two cycles of chemotherapy to evaluate the short-term efficacy were 38 patients and 36 patients,respectively.The total effective rate was39.5%in the DC group and 44.4%in the GC group(P>0.05).The proportion of patients with KPS score improved by≥20 in the GCgroup was significantly higher than that in the DC group(P<0.05).The incidence of thrombocytopenia in the GC group was 30.9%,which was significantly lower than that in the DC group(52.4%,P<0.05).The incidence of diarrhea and fatigue in the GC group was significantly lower than that in the DC group(P<0.05).There was no significant difference in the incidence of other adverse reactions between the two groups(P>0.05).There was a significant decrease in glomerular filtration rate after two cycles of chemotherapy in the DC group(P<0.05).The rate of glomerular filtration was lower in the GC group than that before treatment,but the difference was not statistically significant(P>0.05).The decrease of glomerular filtration rate in the DC group was higher than that in the GC group(P<0.05).After two cycles of chemotherapy,the serum levels of creatinine,urea,β2-MG and cystatin C in the GC group were significantly better than those in the DC group(P<0.05).【Conclusion】The clinical efficacy of DC and GC in the treatment of advanced lung adenocarcinoma complicated with chronic renal insufficiency(decompensated)in elderly patients is similar,but there is a lower risk of nephrotoxicity in GC regimen.