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目的通过回顾性比较顺铂的4组化疗方案治疗不同组织学类型晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者的疗效差别,以期更好地选择化疗目标人群。方法166例NSCLC患者,按组织学类型(鳞癌组94例、腺癌组72例)分别采用TP、GP、NP、DP 4种化疗方案治疗。化疗至少2周期后评价疗效及不良反应。结果总有效率(overall response rate,ORR)为34.9%,鳞癌组与腺癌组ORR分别为38.3%、30.6%。其中,不同化疗方案TP、GP、NP、DP比较,鳞癌组的ORR分别是41.7%、44.0%、34.8%、31.8%;中位生存时间(median survival time,MST)分别为:12.1、12.3、11.7、11.8个月;中位疾病进展时间(time to progression,TTP)分别为:4.4、4.5、3.1、4.4个月;1年生存率分别为:41.7%、44.0%、34.8%、36.4%;腺癌组的ORR分别为27.8%、25.0%、40.0%、28.6%;MST分别为:11.2、11.1、11.5、10.4个月;TTP分别为:3.7、3.2、4.0、4.7个月;1年生存率分别为:33.3%、30.0%、35.0%、35.7%;鳞癌、腺癌组内、组间比较无显著性差异(P>0.05)。主要不良反应是骨髓抑制、恶心、呕吐、静脉炎、脱发。GP组血小板减少发生率(51.1%)最高,且Ⅲ°、Ⅳ°血小板减少达24.4%,与其他组比较具有显著差异(P<0.05)。NP组静脉炎的发生率(37.2%)明显高于其他组(P<0.05)。NP组恶心、呕吐发生率(32.9%)较其他组高(P<0.05)。结论TP、GP、NP、DP 4种化疗方案治疗不同组织学类型NSCLC疗效相似,不良反应存在差异,应根据患者个体情况进行选择。
Objective To compare the efficacy of four groups of chemotherapy regimens of cisplatin in the treatment of patients with advanced non-small cell lung cancer (NSCLC) of different histological types in order to better select the target population of chemotherapy. Methods Sixty-six patients with NSCLC were divided into four groups according to their histological types (94 in squamous cell carcinoma and 72 in adenocarcinoma), and were treated with TP, GP, NP and DP respectively. Chemotherapy at least 2 weeks after the evaluation of efficacy and adverse reactions. Results The overall response rate (ORR) was 34.9%. The ORR of squamous cell carcinoma and adenocarcinoma was 38.3% and 30.6% respectively. The ORR of squamous cell carcinoma was 41.7%, 44.0%, 34.8% and 31.8%, respectively. The median survival time (MST) was 12.1, 12.3 , 11.7 and 11.8 months respectively. The median time to progression (TTP) were 4.4, 4.5, 3.1 and 4.4 months respectively. The 1-year survival rates were 41.7%, 44.0%, 34.8% and 36.4% ; ORR of adenocarcinoma group were 27.8%, 25.0%, 40.0% and 28.6% respectively; MST were 11.2, 11.1, 11.5 and 10.4 months respectively; TTP was 3.7, 3.2, 4.0 and 4.7 months respectively; The survival rates were 33.3%, 30.0%, 35.0% and 35.7% respectively. There was no significant difference between the two groups (P> 0.05). The main adverse reactions are myelosuppression, nausea, vomiting, phlebitis, hair loss. The incidence of thrombocytopenia in GP group was the highest (51.1%), and the thrombocytopenia in Ⅲ ° and Ⅳ ° group was 24.4%, which was significantly different from other groups (P <0.05). The incidence of phlebitis in NP group (37.2%) was significantly higher than that in other groups (P <0.05). The incidence of nausea and vomiting in NP group (32.9%) was higher than that in other groups (P <0.05). Conclusion The four chemotherapy regimens of TP, GP, NP and DP have similar curative effect in different histological types of NSCLC. There are differences in adverse reactions, and they should be selected according to individual patients.