晚期非小细胞肺癌探索性四线及以上治疗的回顾性分析

摘要

Background and objectiveA common consensus has been reached regarding ifrst- and second-line therapies for advanced non-small cell lung cancer (NSCLC). The newest guideline from National Comprehensive Cancer Network (NCCN) also provides recommendations for third-line therapy. This study focused on fourth-line and enhanced treatments for advanced NSCLC. Treatment results and impact factors were analyzed and discussed.MethodsA total of 140 patients with advanced NSCLC were selected and their data were analyzed. Response rate, survival rate, and prognostic factors were evaluated.Results Among the 140 patients, 12.9% (18 cases) showed partial response, 25.7% (36 cases) suffered from a stable disease, and 38.6% (54 cases) exhibited a disease control rate. Median overall survival (OS) and fourth-line therapy OS were 31 months and 10.1 months, respectively. The median progression free survival (PFS) of fourth-line therapy was 2.6 months. Univariate and multivariate analyses indicated different therapy regimens and suggested whether or not patients should undergo follow-up treatments. These parameters were independent prognostic factors of the OS of the fourth-line therapy; by contrast, no independent impact factor of PFS was found. Chemotherapy resulted in better median OS in fourth-line therapy than in targeted therapy (11.7 monthsvs 7.1 months,P=0.013). Considering the median OS of fourth-line therapy, we observed that single agent therapy did not signiifcantly differ from double agent therapy; likewise, we found that ifrst-time usage did not signiifcantly differ from multiple usage of epidermal growth factor receptor tyrosine kinase inhibitor.Conclusion Fourth-line therapy is recommended to increase the survival of advanced NSCLC patients. Nevertheless, the role of fourth-line therapy in advanced NSCLC should be further assessed in clinical trials.%背景与目的晚期非小细胞肺癌的一、二线治疗策略已达成广泛共识，对于三线治疗，最新的美国国立综合癌症网络（National Comprehensive Cancer Network, NCCN）指南中已有相关推荐。本研究旨在研究晚期非小细胞肺癌四线及以上治疗结果及影响因素。方法回顾性分析我院肿瘤中心四线及以上治疗的140例晚期非小细胞肺癌患者的临床资料，对其有效率、生存及预后因素等进行分析。结果18例（12.9%）部分缓解（partial response, PR)，36例（25.7%）疾病稳定（stable disease, SD），疾病控制率（disease control rate, DCR）为38.6%。中位总生存时间（overall survival, OS）及四线治疗后OS分别为31个月及10.1个月。四线治疗中位无疾病进展生存时间（progression free survival, PFS）为2.6个月。单因素及多因素分析均显示不同治疗选择及是否后续治疗是四线OS独立预后因素。未发现四线PFS的独立预后因素。化疗组较靶向组四线中位OS更长（11.7个月vs 7.1个月，P=0.013）。单药及双药化疗，首次及反复使用表皮生长因子受体络氨酸激酶抑制剂（epidermal growth factor receptor tyrosine kinase inhibitor, EGFR-TKI）四线中位OS无差异。结论对有条件接受四线治疗的晚期非小细胞肺癌患者，接受四线治疗能获得生存的延长。四线治疗在晚期非小细胞肺癌的地位值得前瞻性临床试验进一步探讨。