安罗替尼三线及以上治疗中晚期非小细胞肺癌的效果及影响因素分析

Efficacy and influencing factors of Anlotinib as third-line or further treatment for advanced non-small cell lung cancer

目的 探讨真实世界中安罗替尼三线及以上治疗中晚期非小细胞肺癌(NSCLC)的临床效果、安全性及疗效的影响因素。方法 选择2018年6月至2021年1月山东大学齐鲁医院收治的应用安罗替尼三线及以上治疗的77例中晚期NSCLC患者的临床资料,观察安罗替尼的疗效、影响预后的因素及不良反应。结果 所有接受安罗替尼治疗患者的客观缓解率(ORR)和疾病控制率(DCR)分别为9.1%(7/77)、79.2%(61/77),中位无进展生存期(mP FS)和中位总生存期(mO S)分别为4.9个月(95%CI=4.263~5.537)和9.6个月(95%CI=9.133~10.067)。无肺内转移、肝转移、脑转移及三线治疗的患者的DCR高于有肺内转移、肝转移、脑转移及后线治疗的患者,差异有统计学意义(P<0.05)。采用logistic回归模型进行多因素分析,结果显示,治疗线数三线(β=1.496,OR=4.463,95%CI=1.051~18.948)是DCR的独立影响因素(P<0.05)。单因素分析结果显示,mPFS与脑转移、肾上腺转移、肿瘤分期、美国东部肿瘤协作组(ECOG)评分有关,差异有统计学意义(P<0.05);mO S与肝转移、肿瘤分期以及ECOG评分有关,差异有统计学意义(P<0.05)。COX回归分析结果显示,肿瘤分期Ⅲ期(P=0.045,95%CI=0.178~0.981)、ECOG评分0~1分(P=0.031,95%CI=0.350~0.950)是mP FS的独立影响因素,ECOG评分0~1分(P=0.045,95%CI=0.359~0.990)是mO S的独立影响因素。安罗替尼的不良反应主要为1~2级。结论 安罗替尼用于中晚期NSCLC三线及以上治疗的效果较好,可改善患者预后,安全性高。

Objective To investigate the clinical efficacy,safety and efficacy of Anlotinib in the treatment of advanced non-small cell lung cancer(NSCLC) in the real world.Methods The clinical data of 77 patients with advanced NSCLC treated with Anrotinib from June 2018 to January 2021 in Qilu Hospital of Shandong University were analyzed to observe the efficacy of Anrotinib,factors affecting prognosis and adverse reactions.Results The objective response rate(ORR) and disease control rate(DCR) were 9.1%(7/77) and 79.2%(61/77),respectively,and the median progression-free survival(mP FS)and median overall survival(mO S) were 4.9 months(95%CI=4.263-5.537) and 9.6 months(95%CI=9.133-10.067).The DCR of patients without lung metastasis,liver metastasis,brain metastasis and third-line treatment were higher than those of patients with lung metastasis,liver metastasis,brain metastasis and posterior treatment,and the differences were statistically significant(P<0.05).Multivariate analysis using logistic regression model showed that three lines of treatment(β=1.496,OR=4.463,95% CI=1.051-18.948) was the independent influencing factor of DCR(P <0.05).The results of univariate analysis showed that the mP FS was correlated with brain metastasis,adrenal metastasis,tumor stage and ECOG score,and the differences were statistically significant(P<0.05).mO S was associated with liver metastasis,tumor stage and ECOG score,and the differences were statistically significant(P<0.05).COX regression analysis showed that tumor stage Ⅲ(P=0.045,95%CI=0.178-0.981) and ECOG score 0-1(P=0.031,95%CI=0.350-0.950) were independent factors of mP FS,and ECOG score 0-1(P=0.045,95%CI=0.359-0.990) was an independent factor of mO S.The adverse reactions of allotinib were mainly grade 1 to 2.Conclusion Antirotinib is effective in third-line and above treatment of advanced NSCLC,and can improve the prognosis of patients with high safety.