表皮生长因子受体抑制剂gefitinib对改善晚期非小细胞肺癌患者生活质量的作用

背景与目的生活质量是评价非小细胞肺癌治疗方法的重要指标。本研究的目的是观察表皮生长因子受体抑制剂gefitinib对晚期非小细胞肺癌患者生活质量的影响。方法对gefitinib慈善用药计划中31例晚期非小细胞肺癌患者进行研究。患者每日口服gefitinib250mg,直至病情进展或出现严重的副反应。采用中文版EORTCQLQ-C30和QLQ-LC13问卷对治疗前后症状和生活质量的改变进行评价。结果25例接受gefitinib治疗的患者完成问卷。和治疗前相比,治疗8周后,患者4种功能状态(体格、角色、情感、社会)和整体生活质量评分的均值显著增加,全身症状(乏力和食欲不振)以及疾病相关症状(呼吸困难、咳嗽、胸痛、手臂和肩膀疼痛、身体其他部位疼痛)评分的均值显著降低。治疗后5种功能状态和整体生活质量的有效率均超过50%。主要的全身症状和疾病相关症状的有效率也达到44%~84%。症状和生活质量的改善与临床客观疗效相一致。结论gefitinib对于常规治疗失败的晚期非小细胞肺癌仍能够改善患者的症状和生活质量。     

胸腔镜肺叶切除术治疗非小细胞肺癌的临床效果及对血清炎性因子、生活质量的影响

目的探讨胸腔镜肺叶切除术治疗非小细胞肺癌的临床效果及对患者血清炎性因子、生活质量的影响。方法将102例非小细胞肺癌患者按照手术方法的不同分为观察组62例(接受胸腔镜肺叶切除术)和对照组40例(接受传统开胸肺癌根治术)。比较两组患者围手术期的手术相关指标、手术前后的血清炎性因子水平、生活质量和术后并发症的发生情况。结果观察组患者的手术时间、术后住院时间均明显短于对照组患者,术中出血量、胸腔引流量均明显低于对照组患者(P<0.01);术后3天,两组患者的血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和C反应蛋白(CRP)水平均低于本组术前(P<0.05),且观察组患者的血清IL-6、TNF-α和CRP水平均明显低于对照组患者(P<0.01)。术后,观察组患者的肺癌症状量表(LCSS)评分低于对照组患者(P<0.05),术后并发症总发生率明显低于对照组患者(P<0.01)。结论胸腔镜肺叶切除术对非小细胞肺癌患者的创伤较小,可有效减少患者机体的炎性反应和术后并发症的发生,改善患者的生活质量,且安全性较高。     

Analysis of patient-reported outcomes from the LUME-Lung 1 trial: A randomised,double-blind,placebo-controlled,Phase III study of second-line nintedanib in patients with advanced non-small cell lung cancer

IntroductionThe LUME-Lung 1 trial (NCT00805194; Study 1199.13) demonstrated a significant overall survival (OS) advantage for nintedanib plus docetaxel compared with placebo plus docetaxel as second-line therapy for patients with advanced non-small cell lung cancer (NSCLC) and adenocarcinoma histology. Patient-reported outcomes (PROs) for symptoms and health-related quality of life (QoL) are reported here.MethodsPROs were assessed at screening, on Day 1 of each 21-day treatment cycle, at the end of active treatment, and at the first follow-up visit. PRO instruments were the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 and Lung Cancer-13 supplement, and the EuroQol disease-generic questionnaire (EQ-5D and EQ-VAS). Analyses of PRO items for lung cancer-specific symptoms of cough, dyspnoea and pain were prespecified.ResultsRates of questionnaire completion were high. There was no significant difference in time to deterioration of global health status/QoL, or symptoms of cough, dyspnoea or pain, between the treatment groups for both the overall study population and the adenocarcinoma population. Time to deterioration of some gastrointestinal events was shorter with nintedanib versus placebo. Longitudinal analysis for the adenocarcinoma population showed comparable changes between the groups in symptom scores over time, with numerical differences in favour of nintedanib for cough and pain scales, and significant reductions in some pain items with nintedanib versus placebo. There was no statistically significant difference in EQ-5D or EQ-VAS between the groups.ConclusionThe significant OS benefit observed with the addition of nintedanib to docetaxel therapy was achieved with no detrimental effect on patient self-reported QoL.     

Cardiopulmonary morbidity and quality of life in non-small cell lung cancer patients treated with or without postoperative radiotherapy

Aim

To prospectively assess the cardiopulmonary morbidity and quality of life in patients with non-small cell lung cancer (NSCLC) treated with postoperative radiotherapy (PORT) in comparison to those not receiving PORT.

Materials and methods

From 2003 to 2007, 291 patients entered the study; 171 pN2 patients received 3D-planned PORT (PORT group), 120 pN1 patients (non-PORT group) did not. One month after surgery, all patients completed EORTC QLQ C-30 questionnaire and had pulmonary function tests (PFT); cardiopulmonary symptoms were assessed by modified LENT-SOM scale. Two years later, disease-free patients repeated the same examinations. The differences between baseline values and values recorded at two years in QLQ, LENT-SOM and the PFT of the two groups were compared.

Results

In the whole cohort, the rate of non-cancer related deaths was 5.3% and 5.0% in PORT and non-PORT group, respectively. Ninety-five patients (47 - PORT group, 48 - non-PORT group) were included into the final analysis. The differences in the QLQ and cardiopulmonary function (LENT/SOM, PFT) between both groups were insignificant. The forced expiratory volume in one second was on average 12.2% and 1.3% better in the PORT and the non-PORT group, respectively, p = 0.2.

Conclusions

Our findings support the hypothesis about insignificant morbidity of 3D-planned PORT.     

埃克替尼联合胸腔镜治疗非小细胞肺癌的疗效观察

目的 探讨埃克替尼片联合胸腔镜微创治疗对非小细胞肺癌患者的生活质量及血管内皮生长因子C(VEGF-C)的影响.方法 选取2018年12月至2020年6月间盘锦辽油宝石花医院收治的82例非小细胞肺癌患者.采用随机数表法将患者分成对照组和观察组,每组41例.对照组患者采用胸腔镜微创治疗方式,观察组患者采用埃克替尼片联合胸腔...     

综合护理措施对晚期非小细胞肺癌化疗患者癌性疲乏与生活质量的影响

目的探讨综合护理措施对晚期非小细胞肺癌化疗患者癌性疲乏与生活质量的影响。方法选取2018年1月至2019年12月间开封市中心医院收治的进行化疗治疗的88例晚期非小细胞肺癌化疗患者,根据护理方法不同进行分组,采用常规护理措施的44例患者纳入对照组,采用常规护理和综合护理措施的44例患者纳入研究组。比较两组患者化疗前后癌性疲乏情况和生活质量。结果化疗前,两组患者疲乏量表中认知疲乏、躯体疲乏、情感疲乏和行为疲乏评分比较,差异无统计学意义(P>0.05);化疗后,研究组患者各疲乏评分均低于对照组患者,差异均有统计学意义(P<0.05)。化疗前,两组患者生活质量各评分比较,差异无统计学意义(P>0.05);化疗后,研究组患者心理、生理、环境、独立性、精神与社会关系评分均高于对照组患者,差异均有统计学意义(P<0.05)。结论综合护理措施能够有效纠正晚期非小细胞肺癌化疗患者的癌性疲乏情况,改善其生活质量。     

周剂量多西紫杉醇单药治疗晚期老年性非小细胞肺癌

目的:评价周剂量多西紫杉醇(泰索帝,DTX)单药治疗晚期老年非小细胞肺癌(NSCLC)的疗效和安全性。方法:46例年龄>70岁的晚期NSCLC患者接受DTX30mg/m2静脉滴注,第1,8,15天,每4周重复。2周期后进行疗效评价。治疗前、治疗后1月及治疗后2月分别用肺癌患者生存质量测定量表FACT-L中文版进行生活质量(QOL)测评。结果:42例可评价的患者,部分缓解5例,稳定14例,进展23例,临床控制率为45.2%。毒副反应轻微,可以耐受。治疗前与治疗后1月、治疗后2月的QOL分值无显著性差异(P>0.05)。结论:周剂量DTX单药治疗老年晚期NSCLC是安全有效的,毒副反应可以接受,不影响生活质量。     

肠外营养治疗对晚期非小细胞肺癌患者化疗后的临床疗效

目的 观察晚期非小细胞肺癌患者行紫杉醇联合顺铂方案化疗后使用脂肪乳（10%）/ 氨基酸（15）/ 葡萄糖（20%） 注射液的临床疗效。方法 采用回顾性分析方法,选取 2016 年 10 月至 2017 年 10 月的 58 例晚期非小细胞肺癌患者行紫杉 醇联合顺铂方案化疗患者,按化疗后营养补给方式分组,对照组 30 例化疗后常规多瓶输注,观察组 28 例化疗后加以脂肪 乳（10%）/ 氨基酸（15）/ 葡萄糖（20%）注射液输注。比较两组患者化疗前后的人体测量指标、营养指标、免疫功能和 生活质量。结果 两组患者化疗前的一般资料、人体测量指标、营养指标、免疫指标、生活质量评分比较,差异均无统计学 意义（P ＞ 0.05）;观察组化疗后的人体测量指标（BMI、TSF、MAMC）和营养相关血液学指标（HB、TP、PA、ALB） 数值高于对照组,差异有统计学意义（P ＜ 0.05）;观察组化疗后的免疫指标（IgM、IgG、IgA、CD4+ 、CD4+ /CD8+ ）数 值高于对照组,差异有统计学意义（P ＜ 0.05）;观察组化疗后在认知功能、社会功能和总体健康状态的评分显著高于对 照组,差异具有统计学意义（P ＜ 0.05）,观察组在恶心呕吐的症状领域得分低于对照组,差异具有统计学意义（P ＜ 0.05）。 结论 晚期非小细胞肺癌患者化疗后联合脂肪乳（10%）/ 氨基酸（15）/ 葡萄糖（20%）注射液进行肠外营养支持治疗,有 利于改善患者营养状况和增强患者的免疫力,同时提高患者生活质量,值得临床进一步应用。     

吉非替尼治疗非小细胞肺癌有效6个月后疾病进展继续原药治疗的临床观察

目的 观察吉非替尼治疗非小细胞肺癌（NSCLC）有效6个月后疾病进展的患者,应用原药继续治疗的临床表现、生活质量（QOL）及后续生存时间。方法 吉非替尼250mg／d治疗NSCLC有效超过6个月后疾病进展的患者继续原药治疗为试验组（n=39）,6个月后未进展的患者继续维持治疗为对照组（n=49）,采用卡氏行为状态评分（KPS）及癌症患者生活功能指数量表（FLIC）评价两组患者的QOL,并比较试验组不同进展部位对后续生存时间的影响及初始进展至加速进展与加速进展至死亡两个时间段的QOL。结果 试验组患者初始进展KPS及FLIC量表评分维持进展前水平的时间为1.0～24.0个月,中位时间6.0个月,直到死亡前1～3个月与对照组患者的差异无统计学意义（Z=-0.976,P=0.329;Z=-0.029,P=0.977）。试验组初始进展至加速进展与加速进展至死亡两个时间段的KPS评分分别为（85.00±7.31）分和（48.00±9.25）分,差异有统计学意义（P＜0.001）;FLIC量表评分分别为（121.24±18.16）分和（75.57±21.45）分,差异有统计学意义（P＜0.001）。在试验组中,靶病灶进展和非靶病灶进展的后续中位生存时间分别为7.0个月和10.0个月,差异有统计学意义（P=0.018）。结论 吉非替尼治疗NSCLC有效6个月后进展,原药继续治疗在一段时间内仍可能获益,特别是对仅出现非靶病灶进展的患者。     

Assessment of quality of life in advanced non-small-cell lung cancer: an overview of recent randomized trials

Background

Health-related quality of life (HRQOL) parameters are often used as secondary endpoints in advanced non-small-cell lung cancer (NSCLC). We assessed the frequency and correlates of both usage and gain in HRQOL endpoints in NSCLC phase III trials.

Methods

We searched PubMed for phase III trials on systemic anticancer therapies for NSCLC published between 1/98 and 12/09 in 13 leading journals.

Results

The search yielded 122 trials that enrolled a total of 56,031 patients in 273 trial arms. HRQOL was reportedly used as an endpoint in 72 trials (59%). HRQOL parameters were used as primary or co-primary endpoints in nine trials, whereas overall survival (OS) was the primary endpoint or one of the co-primary endpoints in 90 trials. There was no temporal trend for usage of HRQOL parameters as endpoints. Formal statistical comparisons involving HRQOL were reported in 68/72 cases, and a significant difference was found in 37/68 trials (54.4%), 24 of which favored the experimental arm. In many cases, such differences were restricted to specific symptoms or even favored more than one regimen according to symptoms analyzed. We found no significant association between gain in HRQOL and gain in OS or any other trial feature.

Conclusions

HRQOL has been assessed formally in nearly 60% of contemporary phase III trials in advanced NSCLC, and a significant gain in HRQOL has been found in almost one-half of cases. It is questionable, however, whether HRQOL results may help select between treatments with no differential impact on OS.     

Impact of comprehensive geriatric assessment on quality of life,overall survival,and unplanned admission in patients with non-small cell lung cancer treated with stereotactic body radiotherapy

Objectives

Overall survival ?OS? for patients with localized non-small cell lung cancer ?NSCLC? treated with stereotactic body radiotherapy ?SBRT? is poorer than for patients undergoing surgery. Patients who undergo SBRT are often ineligible for surgery due to significant comorbidities that can impact their mortality. A comprehensive geriatric assessment (CGA) that identifies and treats aging related comorbidities could improve OS and quality of life (QoL). This randomized study investigated if a CGA added to SBRT impacts QoL, survival, and unplanned admissions.

全胸腔镜下肺癌根治术与开胸肺癌根治术围手术期结果及淋巴结清扫的比较

目的:比较全胸腔镜下肺癌根治术与开胸肺癌根治术的围手术期结果及淋巴结清扫情况.方法:选取赤峰市第二医院2013年5月至2015年7月行全胸腔镜下肺癌根治术患者62例,2012年4月至2013年5月行开胸肺癌根治术62例,观察两组患者手术时间、术中出血、术后并发症和淋巴结清扫情况.结果:胸腔镜组手术时间(120.6±24.1) min,短于开胸组的(146.3±21.2) min,术中出血量为(210.82±132.62) ml,少于开胸组(252.83±176.45) ml;两组手术时间及手术出血量差异有显著性(P<0.01).胸腔镜组和开胸手术组术后无大出血及再次手术止血的患者,未出现支气管胸膜瘘及脓胸,开胸组术后一例死于肺栓塞.胸腔镜组和开胸手术组的平均淋巴结清扫个数分别为(12.19±6.10)枚和(11.35±7.10)枚,两组差异无显著性(P>0.01).结论:胸腔镜下肺癌根治术创伤小,缩短手术时间,减少并发症,在淋巴结清扫上可以达到与开胸手术一样的效果.     

早期非小细胞肺癌胸腔镜手术与小切口肺切除术后患者生活质量的对比研究

背景与目的:电视辅助胸腔镜手术(video-assisted thoracoscopic surgery,VATS)肺叶切除治疗临床早期非小细胞肺癌(non-small cell lung cancer,NSCLC)术后患者生活质量的系统研究很少.本研究希望通过对比胸腔镜手术与小切口开胸(minimal incision thoracotomy,MIT)肺切除治疗临床早期NSCLC,比较两种术式术后患者生活质量,探讨胸腔镜肺切除术后患者生活质量变化的特点.方法:本研究为前瞻性随机对照研究.从2004年3月至2005年3月CT提示临床早期NSCLC,且肿块直径≤6 cm的患者32例,将其随机分为VATS组(n=17)和MIT组(n=15)两组分别进行手术,VATS组有2例患者因术中不能控制的出血和胸膜广泛粘连转为开胸手术而被剔除.利用肺癌症状量表(Lung Cancer Symptom Scale,LCSS)评估术前和术后第1、3、6个月两组患者的生活质量.结果:两组患者在年龄、性别、肿瘤病理分期、肿瘤直径和术后并发症等方面差异无统计学意义.术后第1个月气促评分(VATS vs.MIT:10.9±7.4 vs.17.4±9.6),疼痛评分(VATS vs.MIT:13.7±9.5vs.23.0±12.2),两组比较差异有统计学意义(P分别为0.047、0.028);其余症状评分两组比较,差异无统计学意义(P＞0.05).肺切除术后VATS组患者症状变化为:第1个月5个主要临床症状(食欲、疲劳、咳嗽、气促和疼痛)均恶化,其中食欲、疲劳和咳嗽与术前相比差异有统计学意义(P＜0.05),术后第3个月症状逐渐恢复,除食欲外逐渐恢复至接近术前水平(P＞0.05),术后第6个月均恢复至术前水平(P＞0.05).结论:对比小切口肺切除,VATS肺切除术后患者具有更高的生活质量,其生活质量恢复的时间需要6个月.     

非小细胞肺癌患者生活质量研究现状

随着医学模式和健康理念的进步,维持良好的生活质量逐渐成为肿瘤治疗的重要目标之一。手术治疗、放疗、化疗等因素均可能严重影响非小细胞肺癌患者的生活质量。研究非小细胞肺癌及其治疗对生活质量的影响有助于掌握患者生活质量水平,实施干预提高生活质量,进而改进全程生存管理并为获得最佳治疗决策提供依据。本文将对近年有关非小细胞肺癌患者生活质量的研究进行综述。