顺铂联合培美曲塞治疗老年晚期非鳞状非小细胞肺癌疗效评价

Evaluation of Clinical Efficacy of Cisplatin Combined with Pemetrexed in Treating Elderly Patients with Advanced Non-Squamous Non-Small Cell Lung Cancer

目的评价顺铂(DDP)联合培美曲塞(PMX)治疗老年晚期非鳞状非小细胞肺癌(NSCLC)的疗效及安全性。方法将2010年1月至2014年1月医院收治的老年晚期非鳞状NSCLC患者80例随机分为PP组及GP组,各40例。GP组采用吉西他滨联合顺铂治疗,PP组采用顺铂联合培美曲塞治疗,化学治疗(简称化疗)至少2个疗程。结果 GP组近期有效率(RR)为15.00%,疾病控制率(DCR)为47.50%,化疗后卡氏生活质量(KPS)评分改善率为30.00%;而PP组RR为27.50%,DCR为77.50%,化疗后KPS评分改善率为52.50%,均显著优于GP组(P<0.05)。治疗后随访PP组患者总生存时间(OS)为8~20个月,中位OS为13.8个月,1年生存率为66.50%,较GP组显著延长(P<0.05)。PP组Ⅰ~Ⅲ度骨髓抑制相关不良反应(白细胞、中性粒细胞及血小板减少)的发生率分别为55.00%,42.50%,40.00%,均显著低于GP组(P<0.05),且胃肠道反应及肾毒性不良反应发生率比GP组亦显著降低(P<0.05)。结论老年晚期非鳞状NSCLC采用顺铂联合培美曲塞治疗,近期疗效显著,并能有效改善患者的生活质量及延长患者的总生存时间,且安全性更好。

Objective To evaluate the efficacy and safety of cisplatin combined with pemetrexed in treating elderly patients with advanced non- squamous non- small cell lung cancer.Methods 80 elderly patients with advanced non- squamous non- small cell lung cancer( NSCLC) were randomly divided into GP group and PP group,40 cases in each group.The GP group was treated with cisplatin combined with gemcitabin,while the PP group was treated with cisplatin combined with pemetrexed.The two groups should be treated no less than 2 courses.Results The RR,DCR and the improvement rate of KPS scores in the GP group were 15.00%,47.50%,30.00%,respectively,which were siginicantly lower than 27.50%,77.50%,52.50% of the PP group( P < 0.05).The OS of the PP group were 8- 20 months,the median OS were 13.8 months,and the 1- year survival rate was 66.5%,which were significant prolonged compared with the GP group( P < 0.05).The incidence rate of Ⅰ- Ⅲ degree of related myelosuppression( leukopenia,neutropenia and thrombocytopenia) were significantly reduced in the PP group,which was 55.00%,42.50% and 40.00%,respectively( P < 0.05).Besides,the gastrointestinal response and nephrotoxicity reactions also showed a statistically reduction compared with the GP group( P < 0.05).Conclusion PMX combined with DDP treatment can effectively improve the recent clinical effect and the quality of life,as well as an extension of the overall survival time of the patients and a better security.