摘要
目的探讨紫杉醇联合卡铂/顺铂(TC/TP)方案一线治疗晚期胸腺癌的疗效和安全性。方法回顾性分析解放军八一医院和南京总医院2008年1月至2017年5月收治的初治晚期胸腺癌患者51例,均经组织病理学和影像学检查确诊。51例患者中接受TC方案化疗23例,TP方案化疗28例。TC或TP方案:紫杉醇135~175 mg/m^2静滴,d_1;卡铂AUC=6静滴,d_2;或顺铂20 mg/m^2静滴,d_1~d_4。均以21天为1个周期,2个周期后按照RECIST 1.1版标准评价近期疗效,按照NCI CTC 4.0版标准评价毒副反应。观察两组的有效率(RR)、疾病控制率(DCR)、无进展生存期(PFS)和总生存期(OS)。结果51例患者均可评价疗效,RR为21.6%,DCR为80.4%;中位PFS和中位OS分别为10.0和22.0个月,1、2和3年生存率分别为84.3%、40.1%和26.1%;1、2和3年无进展生存率分别为32.9%、20.6%和12.4%。其中TC组获部分缓解(PR)4例,稳定(SD)15例,进展(PD)4例,RR为17.4%,DCR为82.6%,中位PFS为10.0个月,中位OS为20.0个月。TP组获完全缓解(CR)1例,PR 6例,SD 15例,PD 6例,RR为25.0%,DCR为78.6%,中位PFS为10.0个月,中位OS为23.0个月。两组RR、DCR、中位PFS和中位OS的差异均无统计学意义(P>0.05)。两组最常见的毒副反应为骨髓抑制,其中3级白细胞减少的发生率分别为8.7%(2/23)和7.1%(2/28),3级血小板减少的发生率分别为8.7%(2/23)和7.1%(2/28),两组比较差异均无统计学意义(P>0.05)。TC组血小板减少的发生率较高,但毒副反应均较轻(1~2级)。单因素生存分析显示,TNM分期、病理类型、恶性程度和是否放疗与晚期胸腺癌的PFS和OS有关;此外,是否手术还与OS有关。结论 TC/TP方案均可作为一线治疗晚期胸腺癌的推荐方案,毒副反应较轻,耐受性好,亦可根据患者个体耐受情况及药物反应适当调整。
Objective To assess the efficacy and safety of paclitaxel combined with carboplatin or cisplatin（ TC/TP） regimen as the first-line treatment for patients with advanced thymic carcinoma. Methods A total of 51 patients with primary advanced thymic carcinoma confirmed by pathologic and imaging examination were retrospectively analyzed and collected from January 2008 to May 2017 in No. 81 Hospital of PLA and General Hospital of PLA. All the 51 patients received chemotherapy,including 23 cases in TC group and 28 cases in TP group. TC regimen was administrated as： paclitaxel 135-175 mg/m^2 iv d1,carboplatin AUC= 6 iv d2; TP regimen was administrated as： paclitaxel 135-175 mg/m2 iv d1,cisplatin 20 mg/m^2 iv d1-d4. Regimens were repeated every 3 weeks. After 6 weeks,response rate（ RR）,disease control rate（ DCR） and toxicity were evaluated according to RECIST version 1. 1 and NCI CTC4. 0 criteria,respectively. The RR,DCR,progression-free survival（ PFS） and overall survival（ OS） were observed in the two groups.Results The RR of all patients was 21. 6% and DCR was 80. 4%. The median PFS（ m PFS） was 10. 0 months and median OS（ m OS）was 22. 0 months. The 1-,2-and 3-year survival rates were 84. 3%,40. 1% and 26. 1% respectively. In addition,the 1-,2-and 3-year progression-free survival rates were 32. 9%,20. 6%,and 12. 4% respectively. Of TC group,there were 4 patients with PR,15 with SD and 4 with PD. The RR of TC group was 17. 4%,DCR was 82. 6%,m PFS was 10. 0 months and m OS was 20. 0 months. Of TP group,there were 1 patient with CR,6 with PR,15 with SD,and 6 with PD. The RR of TP group was 25. 0%,DCR was 78. 6%,m PFS was10. 0 months and m OS was 23. 0 months. There was no statistical difference in RR,DCR,m PFS and m OS between the two groups（ P〉0. 05）. The most common toxicity of the two regimens was myelosuppression. The incidence of grade 3 leukopenia was 8. 7%（ 2/23）and 7. 1%（ 2/28）,and the incidence of grade 3 thrombocytopenia was 8. 7%（ 2/23） and 7. 1%（ 2/28）,respec
作者
李嵘
秦叔逵
朱锡旭
王琳
LI Rong;QIN Shukui;ZHU Xixu;WANG Lin(Department of Radiotherapy,Jinling Hospital Affliated to Medical School of Nanjing University ,Nanjing 210002,China)
出处
《临床肿瘤学杂志》
CAS
北大核心
2018年第4期356-362,共7页
Chinese Clinical Oncology
关键词
胸腺癌
紫杉醇
顺铂
卡铂
联合化疗
预后因素
Thymic carcinoma
Paclitaxel
Cisplatin
Carboplatin
Combined chemotherapy
Prognostic factors
