阿帕替尼治疗晚期及术后复发肺肉瘤样癌的疗效分析

Efficacy of apatinib in the treatment of advanced and postoperative recurrent pulmonary sarcomatoid carcinoma

目的探索阿帕替尼治疗晚期及术后复发肺肉瘤样癌的疗效。方法收集2016年6月至2019年8月Ⅲ~Ⅳ期及术后复发的肺肉瘤样癌患者21例,口服阿帕替尼(250~425 mg/d)治疗,30 d为1个疗程,观察并分析疗效及评价安全性。结果21例患者中,完全缓解(CR)为0,部分缓解(PR)为14.3%(3例),稳定(SD)为33.3%(7例),疾病进展(PD)为52.4%(11例);客观反应率(ORR)为13.3%(3例),疾病控制率(DCR)为47.6%(10例)。中位总生存期(mOS)为4.6个月,中位无进展生存期(mPFS)为1.0个月。病灶≥6 cm(或≥5 cm)较<6 cm(或<5 cm)平均OS明显缩短,差异有统计学意义(P<0.05);术后分期Ⅰ~Ⅱ期较Ⅲ~Ⅳ期平均OS明显延长(P<0.05)。位于中央的病灶较周围的病灶平均OS明显缩短,差异有统计学意义(P<0.01)。性别、年龄(>60岁,≤60岁)、吸烟史(是/否)对疗效影响差异无统计学意义。常见不良反应包括高血压38.1%(8例)、蛋白尿23.8%(5例)、手足综合征28.6%(6例)、腹泻28.6(6例)、骨髓抑制38.1%(8例)。结论阿帕替尼治疗晚期及术后复发肺肉瘤样癌具有一定疗效,不良反应可控,病灶大小、位置及分期可能是疗效的独立影响因素。

Objective To explore the efficacy of apatinib in the treatment of advanced and postoperative recurrent sarcomatoid lung cancer.Methods From June 2016 to August 2019,21 patients with stageⅢ~Ⅳand postoperative recurrence of pulmonary sarcomatoid carcinoma were collected and treated with apatinib(250~425 mg/d),for 30 days as a course of treatment.The efficacy and safety were observed and analyzed.Results In 21 patients,complete response(CR)was 0,partial response(PR)was 14.3%(3 cases),stable disease(SD)was 33.3%(7 cases),and progressive disease(PD)was 52.4%(11 cases);objective response rate(ORR)was 13.3%(3 cases)and disease control rate(DCR)was 47.6%(10 cases).The median overall survival(mOS)was 4.6 months and the median progression-free survival(mPFS)was 1.0 month.The mean OS of lesions≥6 cm(or≥5 cm)was significantly shorter than that of<6 cm(or<5 cm),the difference being statistically significant(P<0.05);the mean OS of stageⅠ~Ⅱwas significantly longer than that of stageⅢ~Ⅳ(P<0.05).The mean OS of the central lesion was significantly shorter than that of the peripheral lesion,the difference being statistically significant(P<0.01).Gender,age(>60 years old,≤60 years old)and smoking history(yes/no)had no significant effect on the efficacy.Common adverse reactions included hypertension(n=8,38.1%),proteinuria(n=5,23.8%),hand-foot syndrome(n=6,28.6%),diarrhea(n=6,28.6%),and bone marrow suppression(n=8,38.1%).Conclusion Apatinib is effective in the treatment of advanced and recurrent pulmonary sarcomatoid carcinoma with controllable adverse reactions.The size,location and stage of the lesion may be the independent affecting factors for the efficacy.