培美曲塞与依托泊苷联合顺铂同步胸部放疗治疗局部晚期肺腺癌的疗效和药物经济学比较研究

背景　同步放化疗是局部晚期非小细胞肺癌（NSCLC）患者的标准治疗方案，但联合的理想化疗方案并未确立。目的　比较培美曲塞联合顺铂（PP方案）与依托泊苷联合顺铂（EP方案）同步胸部放疗治疗局部晚期肺腺癌患者的疗效，并分析两种方案的药物经济学，为治疗方案的选择提供帮助。方法　选取2010—2015年于新疆医科大学附属肿瘤医院放疗中心治疗的局部晚期肺腺癌患者64例为研究对象。根据化疗方案的不同，分为EP组（34例）和PP组（30例）。患者接受相应方案的化疗联合同步胸部放疗，结束后2个月内评价近期疗效，继续随访至2016-12-31，观察远期疗效，记录两组化疗药品费用。结果　两组近期疗效、客观缓解率、疾病控制率、血液学毒性≥3级、放射性食管炎1~2级、放射性肺炎≥2级、消化道反应≥3级、肝功能损伤≥2级的发生率比较，差异均无统计学意义（P>0.05）。EP组1、2年生存率分别为100.0%、24.2%，中位总生存时间为21.0个月〔95%CI（19.7，22.3）个月〕；PP组1、2年生存率分别为83.3%、29.6%，中位总生存时间为21.0个月〔95%CI（18.4，23.6）个月〕；Log-rank检验显示，两组生存曲线比较，差异无统计学意义（χ2=1.896，P=0.169）。PP组总成本高于EP组（P<0.05），成本-效果分析显示，EP组和PP组成本/效果分别为267.35、599.36，Δ成本/Δ效果为3 772.84。结论　PP方案联合同步胸部放疗与EP方案治疗局部晚期肺腺癌的疗效相似，毒副作用可接受，但EP方案更经济适用。

Clinical Efficacy and Pharmacoeconomics of Concomitant Chemoradiotherapy with Pemetrexed or Etoposide plus Cisplatin for Locally Advanced Lung Adenocarcinoma

Background　Concomitant chemoradiotherapy is a standard treatment for patients with locally advanced non-small cell lung cancer （NSCLC）；however，the ideal combined chemotherapy regimen has not been established.Objective　To compare the efficacy of pemetrexed plus cisplatin （PP） and etoposide plus cisplatin （EP） regimens concomitant with chest radiotherapy in the treatment of locally advanced lung adenocarcinoma，and to compare the pharmacoeconomics of these regimens to provide a reference for choosing treatment regimen in the clinic.Methods　Sixty-four patients diagnosed with locally advanced lung adenocarcinoma and treated in the Radiotherapy Center of the Cancer Hospital Affiliated to Xinjiang Medical University between 2010 and 2015 were selected as study subjects.The patients were divided into EP group （n=34） and PP group （n=30） according to the regimen received.The patients were administered a corresponding chemotherapy regimen and radiotherapy.Short-term efficacy was evaluated after 2 months of treatment；the patients were followed up until December 31，2016 to observe long-term efficacy.The costs of the two regimens were also recorded and compared.Results　There were no significant differences in short-term efficacy，objective remission rate，disease control rate，grade ≥3 hematological adverse reactions，grade 1 or 2 radioactive esophagitis，grade ≥2 radioactive pneumonitis，grade ≥3 digestive tract reactions and grade ≥2 liver function damage between the two groups （P>0.05）．The one-year and two-year survival rates in the EP group were 100.0% and 24.2%，respectively，and the median overall survival time was 21.0 months〔95%CI（19.7，22.3）months〕；the one-year and two-year survival rates in the PP group were 83.3% and 29.6%，respectively，and the median overall survival time was 21.0 months 〔95%CI（18.4，23.6）months〕.Log-rank test did not indicate a significant difference in survival curve between the two groups （χ2=1.896，P=0.169）．The total cost of the PP group was higher than that of the EP group （P<0.05）．Cost-effectiveness analysis showed that the cost/effectiveness of the EP group and the PP group was 267.35 and 599.36，respectively，and the Δ cost/Δ effectiveness was 3 772.84.Conclusion　Radiotherapy combined with the PP versus the EP regimen has similar efficacy and safety in the treatment of locally advanced lung adenocarcinoma，while the EP regimen is more economical than the PP regimen.