CAJ | 학술논문

背景与目的小细胞肺癌（small cell lung cancer, SCLC）是恶性程度极高的神经内分泌肿瘤，对放化疗敏感，但大多数接受一线化疗的患者在1年-2年内复发。一旦疾病复发，预后不良。目前，广泛期SCLC的一线标准化疗方案为铂类联合依托泊苷方案，二线化疗方案尚无定论。该研究分析二线化疗预后的影响因素；比较不同二线化疗方案的近期疗效、不良反应和远期生存情况的差异。方法回顾性分析接受二线化疗的181例广泛期SCLC患者的临床资料。根据不同化疗方案分为6组，采用χ2检验比较计数资料和各组组成差异。采用Kaplan-Meier法分析总生存时间（overall survival, OS）和无进展生存时间（progression-free survival, PFS）。采用单因素和Cox回归多因素分析方法分析生存期的影响因素。结果二线化疗的中位OS为7.0个月，单因素和多因素的分析结果表明吸烟情况（P=0.004）、ECOG评分（P<0.001）、肝转移（P=0.019）和骨转移（P=0.028）是影响二线化疗OS的独立影响因素；二线化疗的中位PFS为3.0个月，吸烟（P=0.034）、ECOG评分（P=0.011）和骨转移（P=0.005）是二线化疗PFS的独立影响因素。6组有效率有明显差异（χ2=12.413, P=0.017），两两比较各组无明显差异；副反应方面，伊立替康组胃肠道反应的发生率明显高于其它组；6组的OS和PFS无统计学差异（χ2=1.491, P=0.914；χ2=6.133, P=0.293）。结论ECOG评分是影响广泛期SCLC二线化疗预后的最重要因素。广泛期SCLC的二线化疗尚无疗效确切的最优方案。
배경여목적소세포폐암（small cell lung cancer, SCLC）시악성정도겁고적신경내분비종류，대방화료민감，단대다수접수일선화료적환자재1년-2년내복발。일단질병복발，예후불량。목전，엄범기SCLC적일선표준화료방안위박류연합의탁박감방안，이선화료방안상무정론。해연구분석이선화료예후적영향인소；비교불동이선화료방안적근기료효、불량반응화원기생존정황적차이。방법회고성분석접수이선화료적181례엄범기SCLC환자적림상자료。근거불동화료방안분위6조，채용χ2검험비교계수자료화각조조성차이。채용Kaplan-Meier법분석총생존시간（overall survival, OS）화무진전생존시간（progression-free survival, PFS）。채용단인소화Cox회귀다인소분석방법분석생존기적영향인소。결과이선화료적중위OS위7.0개월，단인소화다인소적분석결과표명흡연정황（P=0.004）、ECOG평분（P<0.001）、간전이（P=0.019）화골전이（P=0.028）시영향이선화료OS적독립영향인소；이선화료적중위PFS위3.0개월，흡연（P=0.034）、ECOG평분（P=0.011）화골전이（P=0.005）시이선화료PFS적독립영향인소。6조유효솔유명현차이（χ2=12.413, P=0.017），량량비교각조무명현차이；부반응방면，이립체강조위장도반응적발생솔명현고우기타조；6조적OS화PFS무통계학차이（χ2=1.491, P=0.914；χ2=6.133, P=0.293）。결론ECOG평분시영향엄범기SCLC이선화료예후적최중요인소。엄범기SCLC적이선화료상무료효학절적최우방안。
Background and objective Small cell lung cancer (SCLC) is the most malignant neuroendocrine tu-mor and sensitive to chemotherapy and radiotherapy. However, most patients who receive ifrst-line chemotherapy will relapse within one to two years. Once recurrent, it indicates poor prognosis. Currently, the standard ifrst-line chemotherapy regimen of extensive-stage SCLC is platinum combined etoposide regimen while the standard second-line chemotherapy regimen is open to debate. hTe aim of this study is to analysis the prognostic factors of second-line chemotherapy in extensive-stage SCLC and to compare the differences of objective response rate, side effects and survival among different second-line chemotherapy regimens. Methods 181 patients who were diagnosed as extensive-stage SCLC and received second-line chemotherapy were collected.χ2 test was used to analysis the differences of enumeration data and between different groups. Kaplan-Meier method was used to calculate the overall survival (OS) and progression-free survival (PFS). Univariate analysis and Cox regression analysis were used to detect the prognostic factors. Objective response rate was evaluated by RECIST criteria and side effects were evaluated by WHO criteria. Results hTe patients who received second-line chemotherapy can be divided into 6 groups, namly group A (CE/EP regimen) 27 cases, group B (regimens containing TPT) 44 cases, group C (regimens containing CPT-11) 33 cases, group D (regimens containing TAX/DXL) 20 cases, group E (regimens containing IFO) 28 cases and group F (other regimens) 29 cases. hTe median OS in second-line chemotherapy as 7.0 months and was relevant with smoking his-tory (P=0.004), ECOG PS (P<0.001), liver metastasis (P=0.019) and bone metastasis (P=0.028) independently. hTe median PFS in second-line chemotherapy as 3.0 months and was relevant with smoking history (P=0.034), ECOG PS (P=0.011) and bone metastasis (P=0.005). hTe response rate among six regimens was signiifcantly different (P=0.017);hTere was not statistical signiifcance between each group. As to side effects, the incidence of gastrointestinal reaction in group C was higher than any other group. hTe differences of OS and PFS between six regimens in second-line therapy were not statistically differ-ent (P=0.914, P=0.293). Conclusion hTe most signiifcant prognostic factor of extensive-stage small cell lung cancer patients who received second-line chemotherapy was ECOG PS. hTe most optimal second-line chemotherapy regimen with deifnite curatice effect was controversial.