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目的:本研究旨在比较拓扑替康、含铂联合化疗和其他单药化疗用于敏感复发小细胞肺癌(small-celllung cancer,SCLC)患者二线化疗的疗效和安全性。方法:回顾性分析83例敏感复发SCLC患者接受二线化疗的疗效和生存情况,并采用COX比例风险模型进行预后的相关因素分析。结果:拓扑替康组、含铂联合化疗组和其他单药化疗组的中位无进展生存期(progression-free survival,PFS)分别为2.80、4.07和1.93个月(P=0.007),二线化疗后的中位总生存期(overall survival,OS)分别为8.07、10.57和7.27个月(P=0.021),Ⅲ～Ⅳ度不良反应发生率分别为47.6%、69.2%和30.0%(P=0.033)。COX比例风险模型分析结果显示,一线化疗疗效(有效与稳定/进展:风险比为1.27,P=0.013)、二线化疗前体能状况评分(0～1分与2分:风险比为1.36,P=0.019)和二线化疗前肿瘤分期(局限期与广泛期:风险比为2.16,P=0.006)是二线化疗OS的独立影响因素。结论:一线化疗有效、体能状况评分为0～1分、二线化疗前局限期患者更能从二线化疗中获益。与拓扑替康和其他单药化疗相比,二线含铂联合化疗的PFS和OS更具优势。
OBJECTIVE: This study was designed to compare the efficacy and safety of topotecan, platinum-containing combination chemotherapy and other single-agent chemotherapy for second-line chemotherapy in patients with sensitive recurrent small cell lung cancer (SCLC). Methods: The curative effect and survival of 83 patients with sensitive and recurrent SCLC undergoing second-line chemotherapy were retrospectively analyzed, and COX proportional hazards model was used to analyze the prognostic factors. Results: The median progression-free survival (PFS) in the topotecan group, platinum-based chemotherapy group, and other single-agent chemotherapy groups was 2.80, 4.07, and 1.93 months, respectively (P=0.007). Second-line chemotherapy The median overall survival (OS) was 8.07, 10.57, and 7.27 months, respectively (P=0.021), and the incidence of III-IV adverse reactions was 47.6%, 69.2%, and 30.0%, respectively (P=0.033). ). COX proportional hazards model analysis showed that the first-line chemotherapy efficacy (effective and stable/progression: hazard ratio was 1.27, P=0.013), physical fitness before second-line chemotherapy score (0 to 1 and 2 points: hazard ratio 1.36, P= 0.019) and second-line chemotherapy before tumor stage (difference period and extensive period: hazard ratio 2.16, P=0.006) were independent factors of second-line chemotherapy OS. Conclusion: Patients with first-line chemotherapy, physical status scores of 0 to 1 and patients with localization before second-line chemotherapy are more likely to benefit from second-line chemotherapy. Compared with topotecan and other monotherapy chemotherapy, PFS and OS with second-line platinum-containing chemotherapy are more advantageous.