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背景与目的随着高效低毒药物的出现,越来越多的晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者有机会接受三线治疗,但目前三线的标准治疗除厄洛替尼外尚无其它选择方案。本研究旨在比较单药化疗、靶向药物与双药联合化疗在晚期NSCLC患者三线治疗中的疗效与安全性。方法回顾分析115例IIIb期/IV期接受三线治疗的NSCLC患者的疗效及生存状况。采用Kaplan-Meier曲线、Cox多因素生存分析模型进行单因素和多因素分析。结果单药组、靶向治疗组与双药联合组中位无进展生存时间(progression free survival,PFS)分别为2.30个月、3.17个月和2.37个月(P=0.045),三线治疗后的中位生存时间(overall survival,OS)分别为8.00个月、10.40个月和7.87个月(P=0.110),III度-IV度毒性反应发生率分别为33.3%、18.2%和68.8%(P<0.001)。多因素分析显示体能状况(per-formance status,PS)评分(P<0.001)是PFS的独立预后因素,既往无吸烟史(P=0.011)、PS评分0分-1分(P<0.001)和一二线治疗疗效获得疾病控制(P=0.044)是三线治疗OS的独立预后因素。结论 PS评分较好、既往不吸烟和一二线治疗疗效疾病控制的患者在三线治疗中更能获益,与化疗单药或双药相比靶向药物组PFS显示出优势。
BACKGROUND & OBJECTIVE: With the emergence of highly effective and low toxic drugs, more and more patients with advanced non-small cell lung cancer (NSCLC) have the opportunity to receive third-line treatment. However, There is no other alternative outside the program. This study was designed to compare the efficacy and safety of single-agent chemotherapy, targeted drugs and dual-agent combination chemotherapy in third-line treatment of patients with advanced NSCLC. Methods The clinical data of 115 patients with stage IIIb / IV NSCLC who underwent third-line treatment were retrospectively analyzed. Kaplan-Meier curves and Cox multivariate survival analysis model were used for univariate and multivariate analysis. Results The median progression-free survival (PFS) of single drug group, target-therapy group and double-drug combination group were 2.30 months, 3.17 months and 2.37 months (P = 0.045) The median overall survival (OS) was 8.00 months, 10.40 months and 7.87 months respectively (P = 0.110). The incidence of grade III-IV toxicity was 33.3%, 18.2% and 68.8% respectively <0.001). Multivariate analysis showed that the per-formance status (PS) score (P <0.001) was an independent prognostic factor for PFS with no history of smoking (P = 0.011) and PS score of 0-1 (P <0.001) First- and second-line treatment of disease control (P = 0.044) is an independent prognostic factor for third-line treatment of OS. Conclusions Patients with better PS score, previous non-smoking and first- and second-line therapies for disease control benefit more from third-line therapy and PFS for the targeted drug group is superior to single-drug or double-drug chemotherapy.