基于倾向性评分匹配法比较培美曲塞或多西他赛联合顺铂治疗Ⅳ期肺腺癌的临床疗效

目的 比较培美曲塞或多西他赛联合顺铂治疗表皮生长因子受体(epidermal growth factor receptor,EGFR)突变状态未知的Ⅳ期肺腺癌的临床疗效。方法 回顾性分析2011年1月至2015年12月贵州医科大学附属医院和贵州省肿瘤医院收治的147例Ⅳ期肺腺癌患者的临床资料。采用倾向性评分匹配法,均衡组间混杂因素后比较培美曲塞+顺铂化疗方案(PP组)与多西他赛+顺铂化疗方案(DP组)的疗效和安全性。结果 倾向性评分匹配后,PP组与DP组的客观缓解率比较差异无统计学意义(60.0% vs 60.0%, χ²<0.001,P>0.999),两组疾病控制率比较差异亦无统计学意义(86.7% vs 82.5%,χ²=0.284,P=0.594);PP组中位OS优于DP组(17.0个月 vs 9.0个月, χ² =4.411,P=0.036),中位PFS亦优于DP组(8.0个月 vs 5.0个月, χ²=4.299,P=0.038);PP组死亡风险较DP组降低52.4%(HR=0.476,95%CI:0.282~0.805,P=0.006);Ⅲ~Ⅳ级中性粒细胞减少发生率低于DP组(28.9% vs 64.4%, χ²=11.429,P=0.001)。结论 在EGFR突变状态未知的Ⅳ期肺腺癌中,培美曲塞+顺铂化疗方案较多西他赛+顺铂化疗方案的临床疗效和预后更好。

Comparison of clinical efficacy of cisplatin combined with pemetrexed or docetaxel in stage Ⅳ lung adenocarcinoma based on propensity score matching

Objective To compare the clinical efficacy of cisplatin therapy involving either pemetrexed  or docetaxel in stage Ⅳ lung adenocarcinoma with unkown epidermal growth factor receptor (EGFR) mutation status. Methods Medical records were collected and analyzed for 147 stage Ⅳ lung adenocarcinoma patients from January 2011 to December 2015. Propensity-score matching (PSM) were performed to further adjust for confounding factors, and then compared the efficacy and safety between pemetrexed plus cisplatin group (PP group) and docetaxel plus cisplatin group(DP group). Results When PSM were performed, PP group and DP group showed similar objective response rates(60.0% vs 60.0%, χ²<0.001,P>0.999) and control rates(86.7% vs 82.5%,χ²=0.284,P=0.594)，then pemetrexed and cisplatin treatment led to longer median survival time(17.0 months vs 9.0 months, χ²=4.411,P=0.036), longer median progression free survival time(8.0 months vs 5.0 months,χ²=4.299,P=0.038), lower risk of death(HR=0.476,95%CI:0.282-0.805,P=0.006), and the rate of grade Ⅲ-Ⅳ neutropenia was lower(χ²=11.429,P=0.001). Conclusions PP regime show a  better  short-time outcome and prognosis compared with DP regime  in patients with  stage Ⅳ lung adenocarcinoma who unkown EGFR mutation status.