顺铂联合多西他赛、培美曲塞及吉西他滨治疗晚期肺腺癌的临床效果比较

目的:比较吉西他滨、培美曲塞、多西他赛联合顺铂三种化疗方案治疗晚期肺腺癌患者的近期疗效与安全性。方法:选择2014年7月至2015年8月在本院肿瘤科住院的经病理或细胞学证实为ⅢB~Ⅳ期肺腺癌的患者共140例,随机分为三组,分别采用多西他赛+顺铂(多西他赛组,n=38)、培美曲塞+顺铂(培美曲塞组,n=56)、吉西他滨+顺铂(吉西他滨组,n=46)三种化疗方案。对三组患者的近期疗效和Ⅲ、Ⅳ度毒性反应的发生情况进行比较。结果:吉西他滨组无完全缓解(CR)患者,部分缓解(PR)患者20例,稳定(SD)患者16例,进展(PD)患者10例,总有效率(RR)43.5%,疾病控制率(DCR)为78.3%;多西他赛组无CR患者,PR患者16例,SD患者12例,PD患者10例,RR42.1%,DCR73.7%;培美曲塞组无CR患者,PR患者28例,SD患者20例,PD患者8例,RR50.0%,DCR为85.7%。三组患者RR及DCR相比较差异无统计学意义(P0.05)。三组化疗方案的主要毒副反应为骨髓抑制,无Ⅲ~Ⅳ度皮疹和末梢神经炎等毒性反应发生。其中,培美曲塞组的严重骨髓抑制即Ⅲ度+Ⅳ度白细胞减少、中性粒细胞减少及血小板减少的发生率明显低于吉西他滨组和多西他赛组(P0.05)。三组化疗方案Ⅲ度+Ⅳ度血红蛋白下降、胃肠道反应、脱发、肝肾功能异常等毒性反应的发生率相比较差异均无显著性(P0.05)。结论:培美曲赛、多西他赛、吉西他滨联合顺铂方案治疗晚期肺腺癌的疗效相当,但培美曲塞组安全性更高。

Comparison of the Clinical Effect of Cisplatin combined with Docetaxel,Pemetrexed and Gemcitabine on Advanced Lung Adenocarcinoma

Objective:To compare the short-term efficacy and safety of gemcitabine, pemetrexed plug, docetaxel and cisplatinthree chemotherapy in the treatment of advanced lung cancer.Methods:A total of 140 cases of patients with IIIB ~ IV lungadenocarcinoma confirmed by pathology or cytology admitted in our hospital from July 2014 to 2015 August were randomly divided tothree groups, which were treated with docetaxel + cisplatin (docetaxel group, n = 38), pemetrexed plus cisplatin (pemetrexed group, n =56), gemcitabine + cisplatin (gemcitabine group, n = 46) respectively. The efficacy and incidence of III, IV toxicity were compared.Results:The total efficiency (RR) of gemcitabine group was 43.5%, disease control rate (DCR) was 78.3%, which were 42.1%, 73.7%and 50.0%, 85.7%in the docetaxel group and pemetrexed respectively. No significant difference was found in the RR and DCR betweenthree groups (P>0.05). The main adverse reaction of three groups was bone marrow suppression, no III ~ IV degree toxicity reaction suchas rash and peripheral neuritis was found. The occurring rate namely the third degree + IV of leukocyte reduction, reduction of neutrophiland platelet of pemetrexed group was significantly lower than those in the group of gemcitabine and docetaxel, (P<0.05). No significantincidence was observed in the grade III + IV decreased hemoglobin, gastrointestinal reaction, alopecia, abnormal liver and kidneyfunction toxicity between three groups (P>0.05).Conclusion:The curative effect of pemetrexed, docetaxel, gemcitabine combined withcisplatin were equal in the treatment of advanced lung adenocarcinoma, but pemetrexed had higher safety.