多西他赛或培美曲塞一线治疗老年晚期肺腺癌的疗效及预后因素分析

目的 探讨多西他赛或培美曲塞单药一线治疗老年晚期肺腺癌的疗效、不良反应及预后因素。方法 回顾性分析我科2008年9月至2012年3月收治的89例老年晚期肺腺癌患者的临床资料，其中多西他赛单药一线化疗组42例，治疗方案：多西他赛75 mg/m2，静脉滴注 d1；培美曲塞单药一线化疗组47例，治疗方案：培美曲塞500 mg/m2，静脉滴注 d1。以上方案均为21天1周期，所有患者至少接受2周期化疗。结果 多西他赛组和培美曲塞组的有效率（RR）、疾病控制率（DCR）、疾病进展时间（TTP）、中位生存期（MST）、1年生存率分别为19.0%和25.5%、61.9%和63.8%、3.0月和3.6、8.5和9月、31.0%和38.3%，两组RR、DCR、TTP、MST、1年生存率间差异均无统计学意义（P>0.05）。培美曲塞组贫血、粒细胞下降、恶心呕吐、腹泻、脱发、疲劳乏力等不良反应低于多西他赛组（P<0.05）。ECOG评分、肿瘤分期、TTP 和有效率是影响老年患者生存的独立预后因素（P<0.05），而性别、年龄、吸烟状态均与患者的预后无关（P>0.05）。结论 多西他赛与培美曲塞单药一线治疗老年晚期肺腺癌的疗效相近，但培美曲塞单药组的不良反应明显低于多西他赛组。

Effi cacy and Prognostic Factors of Docetaxel or Pemetrexed as First-line Treatment for Elderly Patients with Advanced Lung Adenocarcinoma

Objective To evaluate the clinical efficacy, toxicity and prognostic factors of docetaxel orpemetrexed alone as the fi rst-line treatment for elderly patients with advanced lung adenocarcinoma. MethodsRetrospective analysis was adopted to evaluate 89 elderly patients with advanced lung adenocarcinoma(≥65 years) who were hospitalized in the Department of Oncology, Guangzhou General Hospital of GuangzhouMilitary Command, from September 2008 to March 2012. Among them, 42 patients were treated withdocetaxel (75 mg/m2, iv, d1) and 47 patients were treated with pemetrexed (500 mg/m2, iv d1). Three weekswere considered as one session for both of treatments and each of them should be repeated at least twice.Results The response rate(RR), disease control rate (DCR), time to progress(TTP), median survivaltime(MST) and 1 year survival rate of docetaxel and pemetrexed treatments were 19.0% and 25.5%, 61.9%and 63.8%, 3.0 months and 3.6 months, 8.5 months and 9 months, 31.0% and 38.3%, respectively. There wasno signifi cant difference in RR, DCR, TTP, and MST as well as one year survival rate between two treatments(P>0.05). Notably, the side effects including anemia, leukocytopenia,nausea,vomiting,diarrhea,psilosisand fatigue in the pemetrexed group were significantly lower than those in the docetaxel group (P<0.05).Moreover, Cox multivariate regression analysis showed that TTP, ECOG,neoplasm staging and RR wereindependent factors for the survival rate (P<0.05). On the other hand, the factors such as gender, age andsmoking status were not related to the prognosis of survival rate of patients(P>0.05). Conclusion Theeffi cacy was identical between docetaxel and the pemetrexed regimen, but toxicity of latter was much lowerthan that of the former.