恶性胸膜间皮瘤两种化疗方案治疗效果比较

目的探讨恶性胸膜间皮瘤两种内科保守治疗方案培美曲塞联合顺铂与培美曲塞联合卡铂的治疗生存率是否存在差异。方法我院2005—2009年经病理学确诊为恶性胸膜间皮瘤患者17例，临床分期达到Butehart标准Ⅲ期及以上者，分别采用培美曲塞联合顺铂（10例）与培美曲塞联合卡铂（7例）两种方案化疗，对患者的生存率进行统计，了解是否存在差异。结果培美曲塞联合顺铂组患者，早期生存率（1—3个月）略高于培美曲塞联合卡铂组患者，但其差异并无统计学意义（x^2值分别为0、1．52、1．52，P均〉0．05）。中期（4～9个月）生存率培美曲塞联合顺铂组高于培美曲塞联合卡铂组，差异有统计学意义（X2值分别为5．21、4．41、4．41、4．50、4．50、4．55，P均〈0．05）。中远期生存率（10～12个月），培美曲塞联合顺铂组与培美曲塞联合卡铂组生存曲线趋向一致，差异并无统诈学意义（x^2值分别为1．31、0．09、0．09，P均〉0．05）。结论为增加中期生存率，应尽力采用培美曲塞联合顺铂方案。对于部分副反应较大，采用维生素B12及叶酸等辅助药物能够缓解的患者亦应选择此方案。但对于采用了上述方式后仍不能降低副作用者选择培美曲塞联合卡铂的方法也是适当的，尤其是身体虚弱者。

Efficacy comparison of two conservative strategies in the treatment of malignant pleural mesothelioma

Objective To compare the survival rates from two conservative strategies in the treatment of malignant pleural mesothelioma （pemetrexed plus cisplatin or pemetrexed plus carboplatin ）. Methods Seventeen eases diagnosed of malignant pleural mesothetioma at clinical stages of or over Bntchart III in our hospital during 2005 -2009 were treated with pemetrexed plus cisptatin （ 10 cases, Group A）or pemetrexed plus carboplatin （7 cases, Group B ）. The difference in the survival rates between these two groups was compared. Results The early survival rate （0 -3 months）in pemetrexed plus cisplatin （group A）-treated group was more than that of pemetrexed plus carboplatin group （ group B）, but the difference was not statistically significant （ ~2 = 0,1.52,1.52, respectively, P 〉 0.05 ）. For the medium-term survival rate （4 - 9 months）, group A was better than group B, and the difference was statistically significant （X2 = 5.21,4.41,4. 41,4. 50, 4. 50,4. 55, respectively, P 〈 0.05 ）. The two groups produced comparable long-term survival rate s （10- 12 months） （X2 = 1.31,0. 09,0. 09, respectively, P 〉 0. 05 ）. Conclusion To increase the medium-term survival rate （4 -9 months）of patients with MPM ,we prefer to using pemetrexed plus cisplatin regime. For the patients with more severe side effects which can be relieved by folic acid and VitBl2, this regime is also recommended. Otherwise,for the patients with unrelievable side effects, especially for those with poor physical condition or a short survival expectation, pemetrexed plus carboplatin is suggested.