PD-1抑制剂联合抗血管生成药物及化疗二线治疗晚期肺腺癌的临床对比分析

Clinical comparative analysis of PD-1 inhibitor combined with anti-angiogenic drugs and chemotherapy in the second-line treatment of advanced lung adenocarcinoma

目的本研究拟探讨程序性死亡受体1(Programmed cell death 1,PD-1)抑制剂联合抗血管生成药物及化疗二线治疗晚期肺腺癌的临床对比分析。方法回顾性分析河北北方学院附属第一医院2017年1月1日—2020年12月31日期间收治的99例晚期肺腺癌患者临床资料,根据不同治疗方法将患者分为单纯化疗组(n=35)、化疗联合抗血管生成药物组(n=34)和化疗联合抗血管生成药物联合免疫治疗组(n=30)。比较三组患者治疗后的临床疗效及不良反应发生情况。结果三组的疾病控制率(Disease control rate,DCR)分别为48.6%、55.9%和80.0%,差异有统计学意义(P=0.028);客观缓解率(Objective response rate,ORR)分别为11.4%、8.8%和23.3%,差异无统计学意义(P=0.273)。三组中位无进展生存期(Progression-free survival,PFS)分别为2.4个月、4.3个月和6.2个月,差异有统计学意义(P<0.001)。治疗期间三组最常见的不良反应有白细胞减少、恶心呕吐、转氨酶升高、乏力等,大多为1~2级。单因素分析显示临床分期是影响PFS的独立因素。在考虑分组因素情况下,多因素Cox回归分析显示脑转移是PFS的独立影响因素。结论三组对比分析显示二线应用PD-1抑制剂联合抗血管生成药物及化疗治疗晚期肺腺癌的疗效确切且安全性良好。

Objective The aim of this study was to investigate the clinical comparative analysis of anti-angiogenic drugs combined with programmed cell death 1(PD-1)inhibitor and chemotherapy in the second-line treatment of advanced lung adenocarcinoma.Methods A retrospective analysis of 99 patients with advanced lung adenocarcinoma admitted to The First Affiliated Hospital of Hebei North University from January 1,2017 to December 31,2020 was performed.They were divided into the simple chemotherapy group(n=35),chemotherapy combining with anti-angiogenic drugs group(n=34),and chemotherapy combined with anti-angiogenic drugs and immunotherapy group(n=30).The clinical efficacy and adverse reactions of the three groups were compared.Results The disease control rate(DCR)of the three groups were 48.6%,55.9%and 80.0%,respectively,and the difference was statistically significant(P=0.028).The Objective response rate(ORR)was 11.4%,8.8%and 23.3%,respectively,and the difference was not statistically significant(P=0.273).The median progression-free survival(PFS)of the three groups were 2.4 months,4.3 months and 6.2 months,respectively,and the difference was statistically significant(P<0.001).During the treatment,the most common adverse reactions in the three groups were leukopenia,nausea and vomiting,elevated transaminases and fatigue,etc.and most of them were grade 1-2.Univariate analysis showed that clinical stage was an independent factor affecting PFS.Multivariate Cox regression analysis showed that brain metastasis was an independent prognostic factor of PFS after considering grouping factors.Conclusion The comparative analysis of the three groups showed that the second-line application of PD-1 inhibitor combined with anti-angiogenic drugs and chemotherapy in the treatment of advanced lung adenocarcinoma was effective and safe.