摘要
目的探讨培美曲塞和紫杉醇分别与奥沙利铂联合用于治疗术后非小细胞肺癌（NSCLC）患者临床疗效的比较。方法回顾性分析2010年1月至2011年12月在昆明医科大学第一附属医院胸外科治疗的86例原发性NSCLC患者的临床资料。接受培美曲塞联合奥沙利铂（培美曲塞联合组）46例，接受紫杉醇联合奥沙利铂（紫杉醇联合组）40例。用Kaplan-Merie方法进行生存分析，并进行各影响因素与预后关系的单因素和多因素的比较。结果培美曲塞联合组与紫杉醇联合组问中位总生存期（0S）（x2=0．648，P=0．421）、中位无进展生存期（PFS）（x2=0．758，P=0．384）比较差异无统计学意义。本研究中Ⅲ度以上白细胞减少发生率培美曲塞联合组为34．8％，紫杉醇联合组为60．0％，组间比较差异有统计学意义（x2=5．469，P=0．019）；Ⅲ度谷丙转氨酶（ALT）升高发生率培关曲塞联合组为12．2％，紫杉醇联合组为35．0％，组间比较差异有统计学意义（x2=7．238，P=0．007）；Ⅲ度以上谷草转氨酶（AST）升高发生率培美曲塞联合组为13．0％，紫杉醇联合组为32．5％，组间比较差异有统计学意义（x2=4．706，P=0．030）；神经毒性发生率培美曲塞联合组为28．2％，紫杉醇联合组为65．0％，组间比较差异有统计学意义（x2=11.652，P=0．001）；Ⅲ度以上消化道反应发生率培美曲塞联合组为47．8％，紫杉醇联合组为57．5％，组间比较差异无统计学意义（x2=0．803，P=0．370）。预后因素Cox分析显示肿瘤分期[危险系数（HR）=0．089，95％CI：0．041～0．191]、治疗前的体力状况（PS）评分（HR=0．207，95％CI：0．090～0．479）是影响NSCLC术后生存的独立预后因素。结论培美曲塞联合奥沙利铂用于NSCLC术后辅助化学治疗与紫杉醇联合奥沙利铂OS、PFS相似。而培美曲塞联合奥沙利铂较紫杉醇联合奥沙利铂药物的不良反应更低。
Objective To compare the therapeutic efficacies and toxicities either of pemetrexed or paclitaxel combined with oxaliplatin as a chemotherapy in postoperative with non-small-cell lung cancer（NSCLC）. Methods The clinical data collected from 86 patients who admitted into the first affiliated hospital of Kunming medical university from January 2010 to December 2011 who had been diagnosed with non-small-cell lung eancer（NSCLC） were retrospectively analyzed. All of these patients received the radical resection of pulmonary carcinoma,in which 65 patients received pemetrexed combined with oxaliplatin treatment（named as pemetrexed combination group）. Another 40 patients were treated with paclitaxel combined with oxaliplatin （named as paclitaxel combination group）. Survival analysis was evaluated by Kaplan-Merie. Single factor analysis and COX regression model were employed to analyze the relationship between the influencing factors and the prognosis of disease. Results We found that neither OS （x2 = 0. 648, P= 0. 421） nor PFS（x2 =0. 758 ,P=0. 384）was statistical different between two groups. However, the incidence of leucopenia above Ⅲ degrees was 34.8% in pemetrexed combination group, and 60.0% in paclitaxel combination group（x2 = 5. 469, P = 0. 019）. The incidence of of ALT increase above Ⅲ degrees was 12.2% in pemetrexed combination group,and 35.0K in paclitaxel combination group（x2 =7. 238,P=0. 007）. The incidence of AST increase rate above Ⅲ degrees was 13.0% in pemetrexed combination group and 32.5 % in paclitaxel combination group（%2 = 4. 706, P= O. 030）. The incidence of neurotoxicity was 28.2% in pemetrexed combined group,65.0% in paclitaxel combined group （%2 = 11. 652, P = 11. 652）. The incidence of gastrointestinal tract reaction above Ⅲ degrees was 47.8 % in pemetrexed combined group, 57.5 % in paclitaxel combined group was, （%2 = 0. 803, P=0. 370）. Cox regression analysis revealed that PS score（HR=0. 207,95%CI：0. 090-0. 479） and clinical stages（HR=0. 089, 95%CI：0. 041-0. 191） had significant effects on survival of patients. Conclusion Two kinds of treatment in two groups showed the similar curative effects and promised to be first-line chemotherapy strategy for postoperative patients with NSCLC. However, the pemetrexed combined group showed less drug toxicity compared with that of the paclitaxel combined group.
出处
《重庆医学》
CAS
北大核心
2015年第35期4936-4939,共4页
Chongqing medicine
基金
国家自然科学基金资助项目(81060010)
云南省科技计划基金资助项目(2010CD160)
关键词
癌
非小细胞肺
抗肿瘤联合化疗方案
培美曲塞
紫杉醇
奥沙利铂
carcinoma, non-small-cell lung
antineoplastic combined chemotherapy protocols
pemetrexed
paetitaxel
oxaliplatin
