化疗联合吉非替尼靶向治疗晚期非小细胞肺癌的临床观察

Clinical Observation of Chemotherapy Combined with Gefitinib for Treatment of Advanced Non-small Cell Lung Cancer

目的探讨常规化疗联合靶向药物吉非替尼治疗晚期非小细胞肺癌患者的临床疗效。方法回顾性分析2017年6月至2018年9月朝阳市中心医院收治的65例表皮生长因子受体(EGFR)突变阳性晚期非小细胞肺癌患者的临床资料,根据治疗方法不同分为对照组(n=31)和观察组(n=34),其中对照组采用常规化疗方案(多西他赛+吉西他滨+培美曲塞±铂类)进行治疗,观察组在对照组基础上联合靶向药物吉非替尼治疗(每次250 mg,每日1次,直至患者疾病进展或出现难以耐受的不良反应为止),治疗结束后比较两组患者的治疗效果、治疗前后肿瘤标志物[癌胚抗原(CEA)、血管内皮生长因子(VEGF)、糖类抗原199(CA199)]水平变化及不良反应发生情况。结果治疗后,观察组的总有效率高于对照组[76.5%(26/34)比48.4%(15/31)](P<0.05)。CEA水平的组间和时点间存在交互作用(P<0.05),治疗前后两组CEA水平的变化趋势不同(P<0.05),观察组降低CEA的幅度大于对照组;治疗前后VEGF水平的主效应差异有统计学意义(P<0.05),均低于治疗前,组间和时点间不存在交互作用(P>0.05);CA199水平的组间和时点间存在交互作用(P<0.05),治疗前后两组CA199水平的变化趋势不同(P<0.05),观察组降低CA199水平的幅度大于对照组。观察组治疗期间血小板下降、白细胞减少及胃肠道反应的发生率均显著低于对照组[35.3%(12/34)比64.5%(20/31)、32.4%(11/34)比61.3%(19/31)、38.2%(13/34)比80.6%(25/31)](P<0.05),皮疹、血红蛋白下降的发生率比较差异无统计学意义(P>0.05)。结论常规化疗联合吉非替尼治疗晚期非小细胞肺癌总有效率高于单纯常规化疗,能显著降低CA199的水平,且不良反应发生少。

Objective To investigate the clinical efficacy of gefitinib combined with routine chemotherapy in the treatment of patients with advanced non-small cell lung cancer(NSCLC).Methods A retrospective analysis of sixty-five patients with advanced NSCLC treated in Chaoyang Central Hospital from Jun.2017 to Sep.2018 were included and divided into a control group(n=31)and an observation group(n=34)by the treatment methods.The control group was treated with routine chemotherapy(docetaxel+gemcitabine+pemetrexed±platinum)and the observation group was treated with gefitinib(250 mg each time,once a day until the patient refused to take the medicine or the condition worsened)on the basis of the control group′s regimen.After treatment,the therapeutic effect,level of tumor markers[carcinoembryonic antigen(CEA),vascular endothelial growth factor(VEGF),carbohydrate antigen 199(CA199)]and adverse reactions were compared between the two groups.Results After treatment,the total effective rate of the observation group was higher than that of the control group[76.5%(26/34)vs 48.4%(15/31)](P<0.05).There was interaction in CEA level between group and time point(P<0.05),the CEA changing trend in the two groups before and after treatment was different(P<0.05),the decreasing amplitude of CEA in the observation group was bigger than that in the control group;the main effect of VEGF level before and after treatment was statistically significant(P<0.05),both lower than before treatment,and there was no interaction between group and time point(P>0.05);there was interaction in CA199 level between group and time point(P<0.05),the CA199 changing trend in the two groups before and after treatment was different(P<0.05),the decreasing amplitude of CA199 in the observation group was bigger than that in the control group.The incidences of thrombocytopenia,leukopenia and gastrointestinal reaction in the observation group during treatment were significantly were lower than those in the control group[35.3%(12/34)vs 64.5%(20/31),32.4%(11/34)vs 61.3%(19/31),38.2%(13/34)vs 80.6%(25/31)](P<0.05),while there was no statistically significant differences in the incidences of rash and hemoglobin decline(P>0.05).Conclusion Routine chemotherapy combined with first-line targeted drug gefitinib is more effective than routine chemotherapy in the treatment of advanced NSCLC,which can significantly reduce the level of CA199 with less adverse reactions.