存在内科合并症的老年晚期非小细胞肺癌患者一线含铂双药与单药方案化疗的对照研究

目的 探讨含铂双药与第3代化疗药物单药方案化疗在有内科合并症的老年晚期非小细胞肺癌（NSCLC）患者中的疗效和安全性。方法 回顾性分析150例有内科合并症（依据察尔森指数筛选）经细胞学或病理组织学确诊的老年晚期NSCLC患者。按照接受一线化疗方案分为第3代化疗药物单药组（28例）和含铂双药组（122例），比较两组的疗效及不良反应。结果 所有患者均可评价疗效。单药组获PR 6例（21.4％），SD 2例（7.1％），PD 20（71.4％），有效率为21.4％；双药组获PR 48例（39.3％），SD 10例（8.2％），PD64例（52.5％），有效率为393％，两组有效率差异无统计学意义（P＞0.05）。单药组和双药组的中位无进展时间（PFS）分别为5.0个月和7.0个月（P=0.617），中位总生存期（OS）分别为7.4个月和10.7个月（P=0.473）。经年龄、ECOG评分和察尔森指数1～2分分层后发现，单药组与双药组的PFS或OS差异均无统计学意义（P＞0.05）；而经察尔森指数3～4分分层后发现，单药组和双药组的中位PFS分别为3.5个月和8.3个月（P=0.001），中位OS为5.0个月和8.3个月（P=0.019）。不良反应主要包括中性粒细胞减少、贫血、血小板减少和恶心呕吐，单药组不良反应基本为1～2级，双药组3～4级不良反应发生率较单药组高。结论 含铂双药方案一线治疗有内科合并症的老年晚期NSCLC的疗效与第3代化疗药物单药方案类似，而在察尔森指数3～4分患者中前者远期疗效更好，但总体不良反应发生率略高。

A research of platinum-based dual drugs versus single agent chemotherapy for elderly and comorbidity pa- tients with advanced non-small cell lung cancer

Objective To investigate the efficacy and toxicity of single agent and platinum-based dual drugs chemotherapy for elderly and comorbidity patients with advanced non-small cell lung cancer （NSCLC）. Methods A total of 150 cases of elderly NSCLC patients with cytological or pathological diagnosis were retrospectively reviwed. Doublet chemotherapy group was treated with platinum-based dual drugs, and single agent chemotherapy group was treated with the third generation chemotherapy drug monotherapy. Short term effect, progression-free survival （PFS） and overall survival （OS） were observed. Results All the patients could be evalu- ated. In single agent chemotherapy group, PR in 6 cases （ 21.4% ）, SD in 2 cases （ 7. 1% ）, PD in 20 cases （ 71.4% ） , and effective rate was 21.4%, while in doublet chemotherapy group were 48 cases （ 39. 3% ）, 10 cases （ 8.2% ）, 64 cases （ 52. 5% ） and 39. 3%. The effective rate of the two groups had no difference. The median PFS and OS was 5.0 months vs. 7. 0 months（P =0. 617） and 7. 4 months vs. 10. 7 months （P=0. 473 ） in single agent chemotherapy group and doublet chemotherapy group, respectively. There were no statistical differences of survival between the two groups in ECOG scores, age and CCI 1-2. CCI 3-4 patients in doublet chemotherapy group had a better median PFS （3.5 months vs. 8.3 months, P = 0.001 ） and median OS （ 5.0 months vs. 8.3 months, P = 0. 019）than those in single agent chemotherapy group. The main side effects were neutropenia, anemia, thrombocytopenia and nau- sea/vomiting, which were almost in grade 1-2, and grade 3-4 toxicities in doublet chemotherapy group were more than those in single agent chemotherapy group. Conclusion Platinum-based dual drugs regimen has similar short-term and long-term effect to single agent regimen in elderly NSCLC patients. CCI 3-4 patients treated with platinum-based dual drugs has a better survival, but has more side effects.