白蛋白结合型紫杉醇与培美曲塞分别联合顺铂治疗驱动基因阴性晚期肺腺癌的临床观察

Clinical observation of albumin-bound paclitaxel or pemetrexed combined with cisplatin in the treatment of advanced mutation negative lung adenocarcinoma

目的比较白蛋白结合型紫杉醇与培美曲塞分别联合顺铂治疗驱动基因阴性的晚期肺腺癌的近期临床疗效、不良反应及药物经济学。方法将蚌埠医学院第一附属医院呼吸与危重症医学科2019年9月至2020年10月首次确诊的80例晚期肺腺癌患者按随机数字表法分为观察组和对照组, 各40例。观察组采用白蛋白结合型紫杉醇联合顺铂进行治疗, 对照组采用培美曲塞联合顺铂治疗。治疗2周期后评价两组患者近期疗效及不良反应。比较两组患者的化疗药物费用和平均住院日。结果观察组和对照组客观缓解率分别为30.0%(12/40)和32.5%(13/40), 疾病控制率分别为77.5%(31/40)和82.5%(33/40), 差异均无统计学意义(χ^(2)=0.058, P=0.809;χ^(2)=0.313, P=0.576)。两组患者不良反应主要为Ⅰ~Ⅱ级, 观察组白细胞减少、中性粒细胞减少、血小板减少、血红蛋白减少、胃肠道反应、肝功能损害及肾功能损害发生率分别为20.0%(8/40)、20.0%(8/40)、20.0%(8/40)、17.5%(7/40)、37.5%(15/40)、12.5%(5/40)、7.5%(3/40), 对照组分别为25.0%(10/40)、20.0%(8/40)、17.5%(7/40)、15.0%(6/40)、32.5%(13/40)、17.5%(7/40)、5.0%(2/40), 组间比较差异均无统计学意义(χ^(2)=0.287, P=0.592;χ^(2)<0.001, P>0.999;χ^(2)=0.082, P=0.775;χ^(2)=0.092, P=0.762;χ^(2)=0.220, P=0.639;χ^(2)=0.392, P=0.531;χ^(2)<0.001, P>0.999)。观察组的中位化疗药物费用、中位住院天数分别为7 453元、6 d, 均少于对照组的8 956元、7 d, 差异均有统计学意义(Z=-3.057, P=0.002;Z=-2.733, P=0.006)。结论白蛋白结合型紫杉醇联合顺铂与培美曲塞联合顺铂治疗驱动基因阴性的晚期肺腺癌患者近期疗效相当, 不良反应相似, 但白蛋白结合型紫杉醇联合顺铂的平均化疗药物费用较培美曲塞联合顺铂少, 平均住院天数短。

Objective To compare the short-term clinical efficacy,adverse reactions and pharmacoeconomics of advanced mutation negative lung adenocarcinoma treated by albumin-bound paclitaxel or pemetrexed combined with cisplatin.Methods From September 2019 to October 2020,80 patients with advanced lung adenocarcinoma diagnosed in the First Affiliated Hospital of Bengbu Medical College were divided into observation group and the control group according to the randomized digital table,with 40 cases in each group.The observation group received albumin-bound paclitaxel combined with cisplatin,and the control group received pemetrexed combined with cisplatin.After 2 cycles of treatment,the short-term efficacy and the adverse reactions of the two groups were evaluated.The cost of chemotherapy drugs and the average length of hospital stay were compared between the two groups.Results The objective response rates of the observation group and the control group were 30.0%(12/40)and 32.5%(13/40),the disease control rates were 77.5%(31/40)and 82.5%(33/40)respectively,and there were no significant differences(χ^(2)=0.058,P=0.809;χ^(2)=0.313,P=0.576).The adverse reactions of the two groups were mainly gradeⅠ-Ⅱ.The incidences of leucopenia,neutropenia,thrombocytopenia,hemoglobin decreased,gastrointestinal reaction,liver function damage and renal function damage in the observation group were 20.0%(8/40),20.0%(8/40),20.0%(8/40),17.5%(7/40),37.5%(15/40),12.5%(5/40)and 7.5%(3/40)respectively,those in the control group were 25.0%(10/40),20.0%(8/40),17.5%(7/40),15.0%(6/40),32.5%(13/40),17.5%(7/40)and 5.0%(2/40)respectively,and there were no statistically significant differences between the two groups(χ^(2)=0.287,P=0.592;χ^(2)<0.001,P>0.999;χ^(2)=0.082,P=0.775;χ^(2)=0.092,P=0.762;χ^(2)=0.220,P=0.639;χ^(2)=0.392,P=0.531;χ^(2)<0.001,P>0.999).The median cost of chemotherapy drugs and the median length of hospital stay in the observation group were 7453 yuan and 6 days respectively,which were less than 8956 yuan and 7 days in the control group,with statistically significant differences(Z=-3.057,P=0.002;Z=-2.733,P=0.006).Conclusion The short-term efficacy of albumin-bound paclitaxel combined with cisplatin is equal to pemetrexed combined with cisplatin in treatment of advanced mutation negative lung adenocarcinoma,and the adverse reactions are similar.However,the average cost of chemotherapy drugs of albumin-bound paclitaxel combined with cisplatin is less than pemetrexed combined with cisplatin,and the average length of hospital stay is shorter.