培美曲塞联合顺铂治疗老年肺腺癌疗效

Efficacy and safety of pemetrexed plus cisplatin for lung adenocarcinoma in the elderly

【摘要】目的 研究培美曲塞(pemetrexed)联合顺铂一线治疗方案对老年肺腺癌患者的临床疗效。方法 回顾性分析陕西省人民医院2010年1月至2016年6月老年呼吸科、胸外科和肿瘤内科采用培美曲塞联合顺铂方案的肺腺癌住院患者76例,对照组为同期采用吉西他滨联合顺铂和多西他赛联合顺铂方案的肺腺癌住院患者31例,比较两组患者近期和远期疗效。采用SPSS 22.0统计软件对数据进行处理,组间比较采用t检验、χ²检验或Fisher确切概率法。Kaplan-Meier法绘制生存曲线,Log Rank法比较组间差别。结果 两组均无完全缓解(CR)患者,部分缓解(PR)患者比例差异无统计学意义(P＞0.05)。培美曲塞组患者疾病控制率(DCR)为68.42%(52/76),病变进展(PD)患者比例为31.58%(24/76),疾病进展时间(TTP)为(12.8±2.9)个月,3年生存率为31.58%(24/76)；对照组患者 DCR 为54.83%(17/31),PD患者比例为45.16%(14/31),TTP为(10.6±1.8)个月,3年生存率为19.35%(6/31)。相比对照组患者,培美曲塞组患者DCR较高,PD患者比例低,TTP和3年生存率优于对照组,差异有统计学意义(P＜0.05)。Log Rank检验结果也表明培美曲塞组患者远期生存率略优于对照组,差异具有统计学意义(χ²=3.97,P<0.05)。结论 对于表皮生长因子受体(EGFR)野生型的晚期老年肺腺癌患者,培美曲塞联合顺铂方案是较好的可接受治疗方案,患者进展风险低于其他标准治疗方案,且可获得较长的生存期。

基金项目:陕西省自然科学基础研究项目(2014JM2-8167)；陕西省卫生计生委科研项目(2016D036)；西安市科技局社发攻关项目[2016047SF/YX03(4)]；西安医学院优势学科项目(16SXK)；陕西省中医药管理局科研项目(15-JC020)

【Abstract】Objective To analyze the clinical efficacy and safety of pemetrexed combined with cisplatin as first-line treatment in the elderly patients with lung adenocarcinoma. Methods A retrospective study was conducted on 76 elderly patients with lung adenocarcinoma admitted in the departments of geriatric respiratory diseases, medical oncology and thoracic surgery of the Shaanxi Provincial People’s Hospital from January 2010 to June 2016. They received the chemotherapy treatment of pemetrexed combined with cisplatin. Another 31 matched patients undergoing gemcitabine plus cisplatin and docetaxel plus cisplatin in the same period served as control. The short- and long-term efficacies were compared between the 2 groups. The data were processed by using SPSS statistics 22.0. Student’s t test, Chi-square test or Fisher exact test were used to compare the data between groups. Kaplan-Meier survival analysis was used to draw the survival curve, and Log Rank test to compare differences between groups. Results There was no case of complete remission (CR) in both group, and no significant difference in the ratio of partial remission (PR) between the 2 groups (P>0.05). For the pemetrexed group, the disease control rate (DCR) was 68.42% (52/76), the ratio of progression disease (PD) was 31.58% (24/76), the time to progression (TTP) was 12.8±2.9 months, and the 3-year survival rate was 31.58% (24/76). While, in the control group, the above indicators were 54.83% (17/31), 45.16% (14/31), 10.6±1.8 months, and 19.35% (6/31), respectively. The pemetrexed group had obviously higher DCR, lower ratio of PD, and better TTP and 3-year survival rate than the control group (P<0.05). Log Rank test showed that the pemetrexed group was superior to the control group in long-term survival rate (χ²=3.97, P<0.05). Conclusion For the elderly advanced lung adenocarcinoma patients carrying wild type epidermal growth factor receptor (EGFR), pemetrexed combined with cisplatin is an acceptable and better regimen, with lower risk for PD and longer survival rate than other chemotherapy regimens.