多西他赛联合洛铂对老年晚期EGFR阴性非小细胞肺癌病人疗效及免疫功能的影响
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摘要
目的探讨多西他赛联合洛铂治疗老年晚期表皮生长因子受体(EGFR)阴性非小细胞肺癌(non-small cell lung cancer,NSCLC)的疗效及对病人免疫功能的影响。方法选取2014年6月至2016年6月我院收治的年龄>60岁的老年晚期EGFR阴性NSCLC病人90例,按照随机数字表法分为观察组与对照组,每组45例。对照组在常规治疗基础上给予多西他赛联合卡铂治疗,观察组在常规治疗基础上给予多西他赛联合洛铂治疗。对比2组近期临床疗效、1年生存率及中位生存期(MST);检测治疗前后2组病人血清中T淋巴细胞亚群水平并进行比较。结果对照组完全缓解3例,部分缓解22例,稳定12例,进展8例;观察组完全缓解5例,部分缓解27例,稳定9例,进展4例。2组近期疗效分布差异无统计学意义(P>0. 05)。对照组1年生存率为66. 7%,MST为15个月;观察组1年生存率为82. 2%,MST为20个月,2组1年生存率、MST比较差异均有统计学意义(P<0. 05)。治疗前2组病人血清中CD3+、CD4+、CD8+、CD4+/CD8+水平差异无统计学意义(P>0. 05),治疗后2组CD3+、CD4+及CD4+/CD8+水平均显著升高,CD8+水平显著降低(P<0. 05),且观察组上述指标改善均明显优于对照组(P<0. 05)。结论多西他赛联合洛铂治疗老年晚期EGFR阴性NSCLC具有较好的临床综合疗效,可改善病人免疫功能,延长生存时间。
Objective To investigate the effects of docetaxel combined with lobaplatin on the clinical efficacy and immune function in the elderly patients with advanced non-small-cell lung cancer( NSCLC) without epidermal growth factor receptor( EGFR) mutation. Methods A total of 90 patients with advanced NSCLC without EGFR mutation aged ≥60 years old in our hospital from June 2014 to June2016 were randomly divided into control group and observation group,with 45 cases in each group. The patients in the control group were treated with docetaxel and carboplatin on the basis of routine treatment.The patients in the observation group were treated with docetaxel combined with lobaplatin on the basis of routine treatment. The clinical efficacy,survival rate and median survival time( MST) of the two groups were compared. Results In the control group,there were 3 cases of complete response( CR),22 cases of partial response( PR),12 cases of stable disease( SD),and 8 cases of progressive disease( PD),compared with 5,27,9 and 4 in the observation group. There was no statistical difference in the destributaion of clinical efficacy between the two groups( P> 0. 05). The one-year survival rate in the control group was 66. 7% and the MST was 15 months. Compared with 82. 2% and 20 months in the observation group( P< 0. 05). After treatment,the levels of CD3 +,CD4 + and CD4 +/CD8 + increased significantly,and the level of CD8+ decreased significantly in the two groups than those before treatment( P<0. 05),especially in the observation group( P<0. 05). Conclusions Docetaxel combined with lobaplatin has good comprehensive clinical efficacy in the treatment of elderly patients with advanced NSCLC without EGFR mutation,and it can improve the immune function,prolong the survival time.
Objective To investigate the effects of docetaxel combined with lobaplatin on the clinical efficacy and immune function in the elderly patients with advanced non-small-cell lung cancer( NSCLC) without epidermal growth factor receptor( EGFR) mutation. Methods A total of 90 patients with advanced NSCLC without EGFR mutation aged ≥60 years old in our hospital from June 2014 to June2016 were randomly divided into control group and observation group,with 45 cases in each group. The patients in the control group were treated with docetaxel and carboplatin on the basis of routine treatment.The patients in the observation group were treated with docetaxel combined with lobaplatin on the basis of routine treatment. The clinical efficacy,survival rate and median survival time( MST) of the two groups were compared. Results In the control group,there were 3 cases of complete response( CR),22 cases of partial response( PR),12 cases of stable disease( SD),and 8 cases of progressive disease( PD),compared with 5,27,9 and 4 in the observation group. There was no statistical difference in the destributaion of clinical efficacy between the two groups( P> 0. 05). The one-year survival rate in the control group was 66. 7% and the MST was 15 months. Compared with 82. 2% and 20 months in the observation group( P< 0. 05). After treatment,the levels of CD3 +,CD4 + and CD4 +/CD8 + increased significantly,and the level of CD8+ decreased significantly in the two groups than those before treatment( P<0. 05),especially in the observation group( P<0. 05). Conclusions Docetaxel combined with lobaplatin has good comprehensive clinical efficacy in the treatment of elderly patients with advanced NSCLC without EGFR mutation,and it can improve the immune function,prolong the survival time.
引文
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[8]王青,孙开宇,张文利,等.培美曲塞二钠和多西他赛对非小细胞肺癌化疗患者血清Survivin、VEGF水平的影响[J].肿瘤药学,2017,7(2):230-234.
[9]邬麟,蒲兴祥,王倩之,等.伊立替康联合洛铂或卡铂二线治疗广泛期小细胞肺癌94例临床观察[J].肿瘤学杂志,2013,19(11):872-876.
[10]刘继柱,徐文喜,王斌.多西他赛联合洛铂或顺铂治疗晚期非小细胞肺癌的临床研究[J].临床肺科杂志,2014,19(10):1852-1854.
[11]李良,吴瑞锋,刘子滕,等.GP化疗联合同步放疗治疗老年非小细胞肺癌的疗效及对免疫功能、生活质量的影响[J].实用老年医学,2017,31(5):461-464.
[12]陆莎,孙盈,陈召,等.不同化疗方案联合手术治疗非小细胞肺癌的临床疗效及对患者免疫功能的影响分析[J].现代生物医学进展,2016,16(30):5882-5885.
[13]谢成英,金炜,徐永平,等.洛铂对非小细胞肺癌作用的临床前药效学研究[C]//2009医学前沿论坛暨全国肿瘤药理与化疗学术会议,2009.
[2]Gaber R,Watermann I,Kugler C,et al.Preselection of EGFR mutations in non-small-cell lung cancer patients by immunohistochemistry:comparison with DNA-sequencing,EGFR wild-type expression,gene copy number gain and clinicopathological data[J].Rom J Morphol Embryol,2017,58(4):1175-1184.
[3]Hu B,Zhou X,Liu Y,et al.Comparison of chemotherapy plus bevacizumab vs.chemotherapy alone as third-line treatment or beyond for advanced non-small cell lung cancer:Apropensity score-matched analysis[J].Oncol Lett,2018,15(4):5671-5679.
[4]高巍.腔镜下肺癌根治术手术早期NSCLC的效果分析[J].湖南师范大学学报:医学版,2016,13(5):66-69.
[5]Xu R,Zhong G,Huang T,et al.Sequencing of circulating tumor DNA for dynamic monitoring of gene mutations in advanced non-small cell lung cancer[J].Oncol Lett,2018,15(3):3726-3734.
[6]Zhang TW,Rodrigues GB,Louie AV,et al.Phase I study of concurrent and consolidation cisplatin and docetaxel chemotherapy with thoracic radiotherapy in non-small cell lung cancer[J].Curr Oncol,2018,25(1):22-31.
[7]Ikeda S,Kato T,Ogura T,et al.Phase II study of bevacizumab,cisplatin,and docetaxel plus maintenance bevacizumab as first-line treatment for patients with advanced nonsquamous non-small-cell lung cancer combined with exploratory analysis of circulating endothelial cells:Thoracic Oncology Research Group(TORG)1016[J].BMC Cancer,2018,18(1):241-249.
[8]王青,孙开宇,张文利,等.培美曲塞二钠和多西他赛对非小细胞肺癌化疗患者血清Survivin、VEGF水平的影响[J].肿瘤药学,2017,7(2):230-234.
[9]邬麟,蒲兴祥,王倩之,等.伊立替康联合洛铂或卡铂二线治疗广泛期小细胞肺癌94例临床观察[J].肿瘤学杂志,2013,19(11):872-876.
[10]刘继柱,徐文喜,王斌.多西他赛联合洛铂或顺铂治疗晚期非小细胞肺癌的临床研究[J].临床肺科杂志,2014,19(10):1852-1854.
[11]李良,吴瑞锋,刘子滕,等.GP化疗联合同步放疗治疗老年非小细胞肺癌的疗效及对免疫功能、生活质量的影响[J].实用老年医学,2017,31(5):461-464.
[12]陆莎,孙盈,陈召,等.不同化疗方案联合手术治疗非小细胞肺癌的临床疗效及对患者免疫功能的影响分析[J].现代生物医学进展,2016,16(30):5882-5885.
[13]谢成英,金炜,徐永平,等.洛铂对非小细胞肺癌作用的临床前药效学研究[C]//2009医学前沿论坛暨全国肿瘤药理与化疗学术会议,2009.