CAJ | 학술논문

目的研究同步放化疗、序贯放化疗和单纯化疗的局限期小细胞肺癌( SCLC)患者的近期疗效、毒副反应和远期生存情况,以及影响SCLC患者预后的因素.方法回顾性分析166例局限期SCLC患者的临床资料.166例患者中,同步放化疗49例,序贯放化疗62例,单纯化疗55例.采用x2检验比较患者的近期疗效、毒副反应和生存率；采用Kaplan-Meier法计算生存时间(OS)和无进展生存时间(PFS),采用多因素Cox回归分析OS和PFS的影响因素.结果同步放化疗组、序贯放化疗组和单纯化疗组患者的有效率分别为89.4％、67.2％和66.0％,中位OS分别为29.7、22.6和19.5个月,中位PFS分别为12.7、10.8和9.8个月,1年生存率分别为91.1％、86.3％和65.6％,3年生存率分别为44.2％、28.3％和22.8％,5年生存率分别为24.2％、21.4％和11.1％.同步放化疗组、序贯放化疗组和单纯化疗组患者骨髓抑制的发生率分别为84.4％、76.8％和60.0％.同步放化疗组和序贯放化疗组患者放射性食管炎的发生率分别为47.2％和16.7％.多因素分析显示,OS与SCLC患者的性别和ECOG评分显著相关,而PFS仅与ECOG评分显著相关.结论对于局限期SCLC患者,同步放化疗能明显提高有效率.与单纯化疗相比,同步放化疗和序贯放化疗能延长SCLC患者的生存时间,且同步放化疗优于序贯放化疗.同步放化疗患者骨髓抑制和放射性食管炎的发生率明显增加,但大多可以耐受.性别和ECOG评分与SCLC患者的OS显著相关.
목적 연구동보방화료、서관방화료화단순화료적국한기소세포폐암( SCLC)환자적근기료효、독부반응화원기생존정황,이급영향SCLC환자예후적인소.방법 회고성분석166례국한기SCLC환자적림상자료.166례환자중,동보방화료49례,서관방화료62례,단순화료55례.채용x2검험비교환자적근기료효、독부반응화생존솔；채용Kaplan-Meier법계산생존시간(OS)화무진전생존시간(PFS),채용다인소Cox회귀분석OS화PFS적영향인소.결과 동보방화료조、서관방화료조화단순화료조환자적유효솔분별위89.4％、67.2％화66.0％,중위OS분별위29.7、22.6화19.5개월,중위PFS분별위12.7、10.8화9.8개월,1년생존솔분별위91.1％、86.3％화65.6％,3년생존솔분별위44.2％、28.3％화22.8％,5년생존솔분별위24.2％、21.4％화11.1％.동보방화료조、서관방화료조화단순화료조환자골수억제적발생솔분별위84.4％、76.8％화60.0％.동보방화료조화서관방화료조환자방사성식관염적발생솔분별위47.2％화16.7％.다인소분석현시,OS여SCLC환자적성별화ECOG평분현저상관,이PFS부여ECOG평분현저상관.결론 대우국한기SCLC환자,동보방화료능명현제고유효솔.여단순화료상비,동보방화료화서관방화료능연장SCLC환자적생존시간,차동보방화료우우서관방화료.동보방화료환자골수억제화방사성식관염적발생솔명현증가,단대다가이내수.성별화ECOG평분여SCLC환자적OS현저상관.
Objective To study the differences of objective response rate (ORR),side effects and survival among patients with limited-stage small cell lung cancer (LD-SCLC),who received concurrent chemoradiotherapy,sequential chemoradiotherapy or chemotherapy alone,and to analyze the influencing factors on their survival.Methods One hundred and sixty-six patients diagnosed as LD-SCLC in Peking Union Medical College Hospital from January 2000 to December 2009 were included in this study.The differences of objective response rates,side effects and survival rates were analyzed by x2 test.Kaplan-Meier test was used to calculate the overall survival (OS) and progress-free survival (PFS).Cox regression was used to detect the influencing factors on survival time of the patients.Results The patients were divided into three groups:concurrent chemoradiotherapy (49 cases),sequential chemoradiotherapy (62 cases) and chemotherapy alone (55 cases).The chemotherapy was based on CE/EP regimen,with an average cycle of 5.2. Radiotherapy was of a common or 3-dimensional conformal technology,for regular segmentation irradiation with an average dose of 49.6 Gy.The total ORR was 73.4％,OS and PFS were 22.9 months and 10.8 months,1,3,5-year survival rates were 82.7％,31.8％,18.6％,respectively.For the concurrent group,sequential group and chemotherapy alone group,the ORR was 89.4％,67.2％ and 66.0％,respectively.Compared the chemotherapy alone group and concurrent group with the sequential group,there were significant differences ( P ＜ 0.05 ).For the concurrent group,sequential group and chemotherapy alone group,the median OS was 29.7 months,22.6 months,and 19.5 months; the median PFS was 12.7 months,10.8 months,and 9.8 months,respectively,with a non-significant difference between each two groups (P ＞0.05).For the concurrent group,sequential group and chemotherapy alone group,the 1-year survival rates were 91.1％,86.3％,and 65.6％,the 3-year survival rates were 44.2％,28.3％ and 22.8％,and the 5-year survival rates were 24.2％,21.4％ and 11.1％,respectively,with significant differences among them ( P ＜ 0.05 ).The major side effects were myelosuppression,gastrointestinal reactions,radiation pneumonia and radiation esophagitis. For the concurrent group,sequential group and chemotherapy alone group,the incidence of myelosuppression were 84.4％,76.8％ and 60.0％,respectively,with a significant difference (P =0.008) between the concurrent group and chemotherapy alone group.For the concurrent group and sequential group,the incidences of radiation pneumonia were 22.2％ and 22.9％,with a non-significant difference (P =0.940).The incidences of radiation esophagitis were 47.2％ and 16.7％,respectively,with a significant difference (P =0.002).Multivariate analysis showed that OS was significantly associated with gender (P=0.018) and ECOG score (P =0.009),and PFS was significantly associated with gender (P =0.050).Conclusions For LD-SCLC,concurrent chemoradiotherapy can significantly increase the objective response rate. Concurrent chemoradiotherapy and sequential chemoradiotherapy compared with chemotherapy alone can extend survival,and concurrent chemoradiotherapy is better,but the differences among the three regimens are not significant.Gender and ECOG score are important influencing factors of survival.