中国肺癌杂志
中國肺癌雜誌
중국폐암잡지
CHINESE JOURNAL OF LUNG CANCER
2014年
12期
839-844
,共6页
王仙凤%黄媚娟%任莉%徐泳%李潞%侯梅%王瑾%彭枫%朱江%王永生%卢铀
王仙鳳%黃媚娟%任莉%徐泳%李潞%侯梅%王瑾%彭楓%硃江%王永生%盧鈾
왕선봉%황미연%임리%서영%리로%후매%왕근%팽풍%주강%왕영생%로유
肺肿瘤%四线治疗%生存及预后因素
肺腫瘤%四線治療%生存及預後因素
폐종류%사선치료%생존급예후인소
Lung neoplasms%Fourth-line therapy%Survival and prognostic factors
背景与目的晚期非小细胞肺癌的一、二线治疗策略已达成广泛共识，对于三线治疗，最新的美国国立综合癌症网络（National Comprehensive Cancer Network, NCCN）指南中已有相关推荐。本研究旨在研究晚期非小细胞肺癌四线及以上治疗结果及影响因素。方法回顾性分析我院肿瘤中心四线及以上治疗的140例晚期非小细胞肺癌患者的临床资料，对其有效率、生存及预后因素等进行分析。结果18例（12.9%）部分缓解（partial response, PR)，36例（25.7%）疾病稳定（stable disease, SD），疾病控制率（disease control rate, DCR）为38.6%。中位总生存时间（overall survival, OS）及四线治疗后OS分别为31个月及10.1个月。四线治疗中位无疾病进展生存时间（progression free survival, PFS）为2.6个月。单因素及多因素分析均显示不同治疗选择及是否后续治疗是四线OS独立预后因素。未发现四线PFS的独立预后因素。化疗组较靶向组四线中位OS更长（11.7个月vs 7.1个月，P=0.013）。单药及双药化疗，首次及反复使用表皮生长因子受体络氨酸激酶抑制剂（epidermal growth factor receptor tyrosine kinase inhibitor, EGFR-TKI）四线中位OS无差异。结论对有条件接受四线治疗的晚期非小细胞肺癌患者，接受四线治疗能获得生存的延长。四线治疗在晚期非小细胞肺癌的地位值得前瞻性临床试验进一步探讨。
揹景與目的晚期非小細胞肺癌的一、二線治療策略已達成廣汎共識，對于三線治療，最新的美國國立綜閤癌癥網絡（National Comprehensive Cancer Network, NCCN）指南中已有相關推薦。本研究旨在研究晚期非小細胞肺癌四線及以上治療結果及影響因素。方法迴顧性分析我院腫瘤中心四線及以上治療的140例晚期非小細胞肺癌患者的臨床資料，對其有效率、生存及預後因素等進行分析。結果18例（12.9%）部分緩解（partial response, PR)，36例（25.7%）疾病穩定（stable disease, SD），疾病控製率（disease control rate, DCR）為38.6%。中位總生存時間（overall survival, OS）及四線治療後OS分彆為31箇月及10.1箇月。四線治療中位無疾病進展生存時間（progression free survival, PFS）為2.6箇月。單因素及多因素分析均顯示不同治療選擇及是否後續治療是四線OS獨立預後因素。未髮現四線PFS的獨立預後因素。化療組較靶嚮組四線中位OS更長（11.7箇月vs 7.1箇月，P=0.013）。單藥及雙藥化療，首次及反複使用錶皮生長因子受體絡氨痠激酶抑製劑（epidermal growth factor receptor tyrosine kinase inhibitor, EGFR-TKI）四線中位OS無差異。結論對有條件接受四線治療的晚期非小細胞肺癌患者，接受四線治療能穫得生存的延長。四線治療在晚期非小細胞肺癌的地位值得前瞻性臨床試驗進一步探討。
배경여목적만기비소세포폐암적일、이선치료책략이체성엄범공식，대우삼선치료，최신적미국국립종합암증망락（National Comprehensive Cancer Network, NCCN）지남중이유상관추천。본연구지재연구만기비소세포폐암사선급이상치료결과급영향인소。방법회고성분석아원종류중심사선급이상치료적140례만기비소세포폐암환자적림상자료，대기유효솔、생존급예후인소등진행분석。결과18례（12.9%）부분완해（partial response, PR)，36례（25.7%）질병은정（stable disease, SD），질병공제솔（disease control rate, DCR）위38.6%。중위총생존시간（overall survival, OS）급사선치료후OS분별위31개월급10.1개월。사선치료중위무질병진전생존시간（progression free survival, PFS）위2.6개월。단인소급다인소분석균현시불동치료선택급시부후속치료시사선OS독립예후인소。미발현사선PFS적독립예후인소。화료조교파향조사선중위OS경장（11.7개월vs 7.1개월，P=0.013）。단약급쌍약화료，수차급반복사용표피생장인자수체락안산격매억제제（epidermal growth factor receptor tyrosine kinase inhibitor, EGFR-TKI）사선중위OS무차이。결론대유조건접수사선치료적만기비소세포폐암환자，접수사선치료능획득생존적연장。사선치료재만기비소세포폐암적지위치득전첨성림상시험진일보탐토。
Background and objectiveA common consensus has been reached regarding ifrst- and second-line therapies for advanced non-small cell lung cancer (NSCLC). The newest guideline from National Comprehensive Cancer Network (NCCN) also provides recommendations for third-line therapy. This study focused on fourth-line and enhanced treatments for advanced NSCLC. Treatment results and impact factors were analyzed and discussed.MethodsA total of 140 patients with advanced NSCLC were selected and their data were analyzed. Response rate, survival rate, and prognostic factors were evaluated.Results Among the 140 patients, 12.9% (18 cases) showed partial response, 25.7% (36 cases) suffered from a stable disease, and 38.6% (54 cases) exhibited a disease control rate. Median overall survival (OS) and fourth-line therapy OS were 31 months and 10.1 months, respectively. The median progression free survival (PFS) of fourth-line therapy was 2.6 months. Univariate and multivariate analyses indicated different therapy regimens and suggested whether or not patients should undergo follow-up treatments. These parameters were independent prognostic factors of the OS of the fourth-line therapy; by contrast, no independent impact factor of PFS was found. Chemotherapy resulted in better median OS in fourth-line therapy than in targeted therapy (11.7 monthsvs 7.1 months,P=0.013). Considering the median OS of fourth-line therapy, we observed that single agent therapy did not signiifcantly differ from double agent therapy; likewise, we found that ifrst-time usage did not signiifcantly differ from multiple usage of epidermal growth factor receptor tyrosine kinase inhibitor.Conclusion Fourth-line therapy is recommended to increase the survival of advanced NSCLC patients. Nevertheless, the role of fourth-line therapy in advanced NSCLC should be further assessed in clinical trials.
