發(fā)布時(shí)間：2016-05-07 06:26

術(shù)前單療程化療治療ⅢA期非小細(xì)胞肺癌的臨床評價(jià)

【摘要】 目的 探討術(shù)前單療程化療加外科手術(shù)治療ⅢA期非小細(xì)胞肺癌的可行性和毒性反應(yīng)，同時(shí)評價(jià)其對切除率和生存率的影響。方法：從2002年8月~2003年2月，對166例ⅢA期非小細(xì)胞肺癌進(jìn)行前瞻性隨機(jī)對照試驗(yàn)，試驗(yàn)組(術(shù)前化療組)和對照組各83例，前者進(jìn)行術(shù)前化療1個(gè)療程。其中鱗癌44例以CAP方案，腺癌39例以FAD方案治療，化療結(jié)束10~14天后接受手術(shù)；對照組直接行手術(shù)治療。兩組均在術(shù)后行4~6次化療。結(jié)果：試驗(yàn)組化療的有效率為56.7%（47/83），手術(shù)切除率試驗(yàn)組和對照組分別為92.8%（77/83）；85.5%（71/83）。術(shù)后1、2、3、5年生存率試驗(yàn)組和對照組分別為91.6%（76/83），79.9%（58/83），48.2%（40/83），28.9%（24/83）；84.3%（70/83），62.7%（52/83），38.6%（32/83），19.3%（16/83）。兩組手術(shù)并發(fā)癥和手術(shù)死亡率比較均無顯著性差異，生存率比較有顯著性差異。結(jié)論：術(shù)前單療程化療安全、有效，能提高手術(shù)切除率及術(shù)后生存率，同時(shí)并不增加并發(fā)癥發(fā)生率和死亡率。
【關(guān)鍵詞】肺腫瘤   術(shù)前化療   隨機(jī)臨床試驗(yàn)   手術(shù)切除率   術(shù)后生存率

【Abstract】Object  To explore the 1 cycle preoperative chemotherapy in the treatment of stage ⅢA NSCLC and to evaluate its effects on tumor response, resection rate, survival rate. Methods  From Aug 2001 to Jan 2003, 166 patients were randomly divided into group A（preoperative chemotherapy group）and group B（control group, without preoperative chemotherapy）. The patients in group A were give 1 cycle preoperative chemotherapy, and operations were performed in 10 to 14 days after chemotherapy. The regimens included CAP in 44 cases (adenocarcinoma), FAD in 39 cases（squamous）. The patients in group B were firstly operated. 4~6 cycle postoperative chemotherapy were given in all patients in group A and B. Results  The tumor response to induction chemotherapy was 56.7%（47/83）in group A. The resection rate was 92.8%（77/83）in group A, and 85.5%（71/83）in group B. The 1-，2-，3-，5-year survival rate were 91.6%（76/83）、79.9%（58/83）、48.2%（40/83）、28.9%（24/83）in group A, 84.3%（70/83）、62.7%（52/83）、38.6%（32/83）、19.3%（16/83）in group B.   No significant differences of operative complications rate and mortality were observed between the group A and group B. Conclusion The results demonstrate that the 1 cycle preoperative chemotherapy was safe and effective. It was helpful to increase the resection rate and survival rate of the tumor of patients with stage ⅢA NSCLC.
【Key words】lung neoplasm  Preoperative chemotherapy  Randomized clinical trial  Resection rate   Survival rate

人類應(yīng)用術(shù)前化療加外科手術(shù)治療非小細(xì)胞肺癌開始于20世紀(jì)80年代末期[1]。目前，國內(nèi)外報(bào)道多是應(yīng)用2~3個(gè)療程的術(shù)前化療，而術(shù)前進(jìn)行單療程化療則鮮有報(bào)道。為了評價(jià)術(shù)前單療程化療的有效性、毒副反應(yīng)和對手術(shù)切除率和生存率的作用，我科從2001年8月~2003年1月，對166例ⅢA期NSCLC施行術(shù)前單療程化療，現(xiàn)將結(jié)果報(bào)告如下。

資料和方法

本組病例為我院2001年8月~2003年1月收治的部分ⅢA期NSCLC患者共166名，全部病例均有術(shù)前病理學(xué)或細(xì)胞學(xué)診斷以及術(shù)后病理學(xué)診斷。采用隨機(jī)抽簽法分別進(jìn)入試驗(yàn)組(術(shù)前化療組)和對照組(單純手術(shù)組)。兩組各83例。兩組患者的一般資料見表1。

結(jié)    果
討  論

綜上所述，單療程術(shù)前化療用于治療 ⅢA期NSCLC，住院時(shí)間短，經(jīng)濟(jì)消耗低，，能夠比較有效地縮小瘤體，提高手術(shù)切除率及生存率，而不增加手術(shù)并發(fā)癥和死亡率，是較適合臨床實(shí)際應(yīng)用的輔助治療方法。

參考文獻(xiàn)

1 Johnson DH, Strupp J, Greco FA, et al. Neoadjuvant cisplatin plus vinblastine chemotherapy in locally advanced non-small cell lung cancer. Cancer, 1991, 86（6）: 1216-1220.

2 周清華. 肺癌外科治療的新理論和新技術(shù). 中國肺癌雜志，2000，3(6)：406-410.
3 吳一龍. 非小細(xì)胞肺癌的術(shù)前術(shù)后綜合治療. 中國肺癌雜志，2000，3(6)：415-418.
4 Obrer AA, Martin DE, Alonso PD, et al. Surgery and combined therapy for non-small cell lung cancer with invasion of the mediastinal node. A retrospective study. Arch Bronconeumol, 2001,37(4): 160-165.
5 Boer RH, Smith IE, Postorino U, et al. Preoperative chemotherapy in early stage respectable non-small cell lung cancer: arandomized feasibility study justifying a multicenter phase Ⅲ trial. Br J Cancer, 1999,79(9): 1514-1518.
6 Eberhardt W, Wike H, Stamatis G, et al. Preoperative chemotherapy followed by concurrent chemoradiation therapy based on hyperfractionated accelerated radiotherapy and definitive surgery in locally advanced non-small cell lung cancer: mature results of a phase Ⅱtrial. J Clin Oncol, 1998, 16(3): 622-634.
7 Albain KS, Pass HI. Induction therapy before surgery for non-small cell lung cancer. Lung Cancer, 2000,29(Suppl 1):168-171.
8 Saito Y, Minami K, Kobayashi M, et al. Ten year’s experience of induction therapy for locally advanced NSCLC: a single institute study. Lung Cancer, 2000,29(Suppl 1):89.
9 Pitz C, Riviere BDI, Beek FV, et al. Phase Ⅱstudy of induction chemotherapy in patients with stage ⅢB NSCLC. Lung Cancer, 2000,29(Suppl 1): 89.
10 周清華,劉倫旭,李潞等.術(shù)前新輔助化療加外科手術(shù)治療Ⅲ期非小細(xì)胞肺癌的隨機(jī)對照臨床試驗(yàn). 中國肺癌雜志,2001,4(4), 251-256.
11 李強(qiáng)，宋煜宏，鄭智元等.Ⅲ期非小細(xì)胞肺癌術(shù)前短療程化療的臨床評價(jià).腫瘤防治雜志.2003,10(5)，505-507.
12 姚珂，向明章，閔家新等. Ⅲ期非小細(xì)胞肺癌術(shù)前新輔助化療的隨機(jī)對照臨床試驗(yàn).中國腫瘤臨床.2004,31(11),611-613.
13 Date H, Kiura K, Aoe M, et al. Surgical resection of non-small cell lung cancer with mediastinal lymph node metastases after induction chemotherapy with cisplatin and irinotecan. Lung Cancer, 2000,29(Suppl 1): 91. 
14 Betticher DC, Hsu SF, Gauthier Y, et al. Neoadjuvant therapy with Docetaxel (TAX) and cisplatin (Cis) in patients (pts) with non-small cell lung cancer (NSCLC), stage ⅢA, N2 is highly activity with few toxicities. Lung Cancer, 2000,29(Suppl 1): 99.

本文編號：42763