目的 回顧性分析吉非替尼聯(lián)合順鉑治療晚期非小細胞肺癌的臨床療效。方法 選取2017年2月-2020年4月淮南東方醫(yī)院集團總醫(yī)院收治的60例晚期非小細胞肺癌,根據(jù)用藥方案不同分為對照組和治療組,每組各30例。對照組化療第1天靜脈滴注注射用培美曲塞二鈉,500 mg/m²,注射時間大于10 min,化療第1~3天靜脈滴注順鉑注射液,75 mg/m²,給藥前2~16 h和給藥后至少6 h內(nèi)必需進行充分的水化治療。治療組從化療第1天開始口服吉非替尼片,250 mg/d,同時化療第1~3天靜脈滴注順鉑注射液,用法用量同對照組。兩組均以3周為1個療程,治療2個療程。觀察兩組的臨床療效,比較兩組治療前后生活質(zhì)量相關(guān)評分、免疫功能指標、腫瘤標志物、血清細胞因子水平的變化情況。結(jié)果 治療后,治療組客觀緩解率(ORR)、疾病控制率(DCR)分別是60.0%、90.0%,顯著高于對照組的33.3%、70.0%(P<0.01)。治療后,對照組軀體、心理、社會、總分均顯著低于治療前(P<0.05),兩組KPS評分顯著高于治療前(P<0.05);治療后治療組患者軀體、心理、社會、總分及KPS評分均顯著高于對照組(P<0.05)。治療后,治療組CD4⁺和CD4⁺/CD8⁺均顯著上升,CD8⁺下降(P<0.05);對照組CD4⁺和CD4⁺/CD8⁺均顯著下降(P<0.05),CD8⁺有上升趨勢但無統(tǒng)計學(xué)意義。治療后,治療組患者CD4⁺和CD4⁺/CD8⁺顯著高于對照組,CD8⁺低于對照組(P<0.05)。治療后,兩組癌胚抗原(CEA)、神經(jīng)元特異性烯醇化酶(NSE)、血管內(nèi)皮生長因子(VEGF)均顯著下降(P<0.05);且治療后治療組CEA、NSE、VEGF水平顯著低于對照組(P<0.05)。治療后,兩組患者白細胞介素-2(IL-2)、白細胞介素-6(IL-6)、腫瘤壞死因子-α(TNF-α)、干擾素-γ(INF-γ)顯著升高,而白細胞介素-4(IL-4)顯著降低(P<0.01);且治療后,治療組IL-6和INF-γ顯著高于對照組(P<0.05)。隨訪發(fā)現(xiàn),治療組總生存率(OS)、無進展生存率(PFS)中位生存時間分別為20.6、28個月,對照組為16、19個月。Log-rank (Mantel-Cox) test結(jié)果顯示,治療組PFS顯著優(yōu)于對照組(P<0.05),而OS雖有一定趨勢但無顯著性差異。結(jié)論 吉非替尼聯(lián)合順鉑可有效治療晚期非小細胞肺癌患者,提高ORR、DCR,改善患者攜瘤生活質(zhì)量,提高無進展生存率,且無顯著不良反應(yīng)。

Objective The clinical efficacy of gefitinib combined with cisplatin in treatment of advanced non-small cell lung cancer was retrospectively analyzed. Methods Patients (60 cases) with advanced non-small cell lung cancer admitted to Huainan Oriental Hospital Group General Hospital from February 2017 to April 2020 were selected and divided into control and treatment group according to different medication regimen, with 30 cases in each group. Patients in the control group were iv administered with Pemetrexed Disodium for injection, 500 mg/m², the injection time is longer than 10 min, and on the 1st to 3rd day of chemotherapy, they were iv administered with Cisplatin Injection, 75 mg/m², and adequate hydration treatment is necessary for 2 to 16 h before and at least 6 h after administration. Patients in the treatment group were po administered with Gefitinib Tablets, 250 mg/d. And on the 1st to 3rd day of chemotherapy, Cisplatin Injection was injected intravenously with the same dosage as the control group. 3 Weeks was as 1 course, and two groups were treated for 2 courses. The clinical effects of the two groups were observed, and the changes of quality-of-life scores, immune function indexes, tumor markers and serum cytokine levels before and after treatment were compared between the two groups. Results After treatment, the objective response rate (ORR) and disease control rate (DCR) in the treatment group were 60.0% and 90.0%, respectively, which were significantly higher than those in the control group (33.3% and 70.0%, P < 0.05). After treatment, the physical, psychological, social, and total score of the control group were significantly lower than before treatment (P < 0.05), and the Cassiar score of the two groups were significantly higher than before treatment (P < 0.05). After treatment, the physical, psychological, social, total score and Carlisle score of the treatment group were significantly higher than those of the control group (P < 0.05). After treatment, CD4⁺ and CD4⁺/CD8⁺ in treatment group were significantly increased, while CD8⁺ was decreased (P < 0.05). In the control group, CD4⁺ and CD4⁺/CD8⁺ were significantly decreased (P < 0.05), while CD8⁺ showed an upward trend without statistical significance. After treatment, CD4⁺ and CD4⁺/CD8⁺ in treatment group were significantly higher than those in control group, and CD8⁺ was lower than those in control group (P < 0.05). After treatment, CEA, NSE and VEGF were significantly decreased in both groups (P < 0.05). After treatment, the levels of carcinoembryonic antigen (CEA), neuron-specific enolase (NSE) and vascular endothelial growth factor (VEGF) in treatment group were significantly lower than those in control group (P < 0.05). After treatment, interleukin-2 (IL-2), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and interferon-γ (INF-γ) were significantly increased in both groups, while interleukin-4 (IL-4) was significantly decreased (P < 0.01). After treatment, IL-6 and INF-γ in the treatment group were significantly higher than those in the control group (P < 0.05). The median survival time of overall survival (OS) and progression-free survival (PFS) was 20.6 and 28 months in the treatment group and 16 and 19 months in the control group, respectively. Log-rank (Mantel-Cox) test results showed that PFS in the treatment group was significantly better than that in the control group (P < 0.05), while OS had a certain trend but no significant difference. Conclusion Gefitinib combine with cisplatin can effectively treat advanced non-small cell lung cancer, and can improve ORR, DCR, the quality of life and progression-free survival rate, which was no significant adverse reactions.

R979.1