影响晚期肺鳞癌一线化疗疗效的临床因素分析

Clinical factors affecting the efficacy of first-line chemotherapy in metastatic lung squamous cancer

目的:分析影响铂二联方案一线治疗晚期肺鳞癌的临床因素,为一线治疗提供临床依据。方法:回顾性分析2008年6月至2012年12月109例经病理及影像学检查确诊、一线应用铂二联方案化疗的IV期肺鳞癌患者的临床因素,包括:性别、年龄、是否吸烟、是否存在远处转移、一线化疗方案、一线方案的疗效及周期数、是否接受局部放疗及二线治疗;分析这些临床因素对一线方案近期及远期疗效的影响。近期疗效用客观有效率代表,远期疗效用中位生存期代表。结果:109例患者中,部分缓解者35例,疾病稳定者34例,疾病进展者40例,客观有效率32.1%,疾病控制率63.3%。中位生存期为12.00个月(95%CI:11.05~12.95个月),一线治疗中位至疾病进展时间为5.0个月(95%CI:4.26~5.74个月)。单因素分析表明患者性别、年龄、是否吸烟、是否存在远处转移、一线方案对一线化疗疗效的影响不具有统计学意义。Kaplan-Meier分析及COX回归分析均表明:性别、年龄、是否吸烟、治疗前是否存在远处转移以及一线方案对患者生存期的影响不具有统计学意义;而一线化疗疗效、一线化疗周期数、是否接受局部放疗及二线治疗则对患者生存期的影响具有统计学意义。结论:一线化疗的疗效及周期数、是否接受二线治疗及局部放疗是影响晚期肺鳞癌患者预后的独立因素。

Objective: To analyze the clinical factors affecting the efficacy of platinum doublets as first- line chemotherapy in advanced squamous lung cancer. Methods: We analysed the clinical data of 109 patients with stage IV squamous lung cancer which were diagnosed by pathology and imaging treated with platinum doublets. The clinical factors include Gender,age,smoke or not,distant metastasis or not,chemotherapy cycles,radiotherapy,and second-line chemotherapy. Objective response rate was used to represent the recent efficacy and median survival time was used to represent long- time efficacy. Results: In the 109 patients,35 patients had got partial remission,34 stable diseases and 40 progressed diseases. The objective response rate was 32. 1%,diesease control rate was 63. 3%. Median survival time was 12 months( 95% confidence interval 11. 05 ~ 12. 95 months),the median time to progression was 5months( 95% confidence interval 4. 26 ~ 5. 74 months). Univariate analysis showed that gender,age,smoke or not,distant metastasis,first- line chemotherapy regimens had no significant effect on the objective response rate. Kaplan-Meier analysis and COX regression analysis showed that gender,age,smoke,distant metastasis and chemotherapy regimen had no significant effect on median survival time,but showed that efficacy and cycles of first- line chemotherapy,radiotherapy and second- line chemotherapy had significant effect on median survival time. Conclusion: The efficacy and number of cycles of first- line chemotherapy,radiotherapy and second- line chemotherapy were the prognostic factors in advanced squamous lung cancer.