目的:观察阿帕替尼联合放疗同步多西他赛与顺铂化疗治疗驱动基因阴性非小细胞肺癌(NSCLC)脑转移瘤患者的近期疗效和安全性。方法:收集2018年6月至2019年6月在我院收治的NSCLC脑转移患者72例,二代基因测序(NGS)显示驱动基因阴性,数字随...目的:观察阿帕替尼联合放疗同步多西他赛与顺铂化疗治疗驱动基因阴性非小细胞肺癌(NSCLC)脑转移瘤患者的近期疗效和安全性。方法:收集2018年6月至2019年6月在我院收治的NSCLC脑转移患者72例,二代基因测序(NGS)显示驱动基因阴性,数字随机分组法分为对照组36例、治疗组36例,对照组接受多西他赛、顺铂方案化疗2个周期及同步脑转移瘤放疗,治疗组在观察组基础上给予阿帕替尼抗血管生成治疗。主要研究终点:确认有效率(cORR)和疾病控制率(DCR);次要研究终点:无进展生存期(PFS),生存质量(QOL)评分,血清癌胚抗原(CEA),血管内皮生长因子(VEGF)及药物不良事件(AE)发生率。结果:与对照组相比,治疗组cORR和DCR明显提高[41.67%(15/36)vs 33.33%(12/36)、80.56%(29/36)vs 69.44%(25/36),均P<0.05];中位PFS明显延长(5.9 vs 4.6个月,P<0.05);血清CEA和VEGF值显著降低[(16.5±2.3)vs(22.9±3.7)ng/ml、(291.6±42.6)vs(479.3±50.2)pg/ml,P<0.05];而QOL评分治疗组[(69.5±8.5)分]虽略高于对照组[(64.1±7.3)分],但差异无统计学意义(P>0.05)。两组患者在急性脑水肿、胃肠反应、骨髓抑制、肝功能减退发生率的差异无统计学意义(均P>0.05),治疗组口腔黏膜炎、手足综合征、高血压、蛋白尿发生率明显高于对照组(均P<0.05)。结论:阿帕替尼联合放化疗在驱动基因阴性NSCLC脑转移患者中的疗效明显优于单纯放化疗,且不良反应可控,值得临床推荐。展开更多
High expression of fibrinogen and platelets are often observed in non–small cell lung cancer(NSCLC) patients with local regional or distant metastasis. However, the role of these factors remains unclear. The aims of ...High expression of fibrinogen and platelets are often observed in non–small cell lung cancer(NSCLC) patients with local regional or distant metastasis. However, the role of these factors remains unclear. The aims of this study were to evaluate the prognostic significance of plasma fibrinogen concentration and platelet count, as well as to determine the overall survival of NSCLC patients with brain metastases. A total of 275 NSCLC patients with brain metastasis were enrolled into this study. Univariate analysis showed that high plasma fibrinogen concentration was associated with age ≥ 65 years(P = 0.011), smoking status(P = 0.009), intracranial symptoms(P = 0.022), clinical T category(P = 0.010), clinical N category(P = 0.003), increased partial thromboplastin time(P < 0.001), and platelet count(P < 0.001). Patients with low plasma fibrinogen concentration demonstrated longer overall survival compared with those with high plasma fibrinogen concentration(median, 17.3 months versus 11.1 months; P ≤ 0.001). A similar result was observed for platelet counts(median, 16.3 months versus 11.4 months; P = 0.004). Multivariate analysis showed that both plasma fibrinogen concentration and platelet count were independent prognostic factors for NSCLC with brain metastases(R2 = 1.698, P < 0.001 and R2 = 1.699, P < 0.001, respectively). Our results suggest that high plasma fibrinogen concentration and platelet count indicate poor prognosis for NSCLC patients with brain metastases. Thus, these two biomarkers might be independent prognostic predictors for this subgroup of NSCLC patients.展开更多
文摘目的:观察阿帕替尼联合放疗同步多西他赛与顺铂化疗治疗驱动基因阴性非小细胞肺癌(NSCLC)脑转移瘤患者的近期疗效和安全性。方法:收集2018年6月至2019年6月在我院收治的NSCLC脑转移患者72例,二代基因测序(NGS)显示驱动基因阴性,数字随机分组法分为对照组36例、治疗组36例,对照组接受多西他赛、顺铂方案化疗2个周期及同步脑转移瘤放疗,治疗组在观察组基础上给予阿帕替尼抗血管生成治疗。主要研究终点:确认有效率(cORR)和疾病控制率(DCR);次要研究终点:无进展生存期(PFS),生存质量(QOL)评分,血清癌胚抗原(CEA),血管内皮生长因子(VEGF)及药物不良事件(AE)发生率。结果:与对照组相比,治疗组cORR和DCR明显提高[41.67%(15/36)vs 33.33%(12/36)、80.56%(29/36)vs 69.44%(25/36),均P<0.05];中位PFS明显延长(5.9 vs 4.6个月,P<0.05);血清CEA和VEGF值显著降低[(16.5±2.3)vs(22.9±3.7)ng/ml、(291.6±42.6)vs(479.3±50.2)pg/ml,P<0.05];而QOL评分治疗组[(69.5±8.5)分]虽略高于对照组[(64.1±7.3)分],但差异无统计学意义(P>0.05)。两组患者在急性脑水肿、胃肠反应、骨髓抑制、肝功能减退发生率的差异无统计学意义(均P>0.05),治疗组口腔黏膜炎、手足综合征、高血压、蛋白尿发生率明显高于对照组(均P<0.05)。结论:阿帕替尼联合放化疗在驱动基因阴性NSCLC脑转移患者中的疗效明显优于单纯放化疗,且不良反应可控,值得临床推荐。
基金supported by grants from Ministry of Science and Technology Projects of China(No.2012AA021502)Provincial Science and Technology Projects of Guangdong(No.2012B031800295)
文摘High expression of fibrinogen and platelets are often observed in non–small cell lung cancer(NSCLC) patients with local regional or distant metastasis. However, the role of these factors remains unclear. The aims of this study were to evaluate the prognostic significance of plasma fibrinogen concentration and platelet count, as well as to determine the overall survival of NSCLC patients with brain metastases. A total of 275 NSCLC patients with brain metastasis were enrolled into this study. Univariate analysis showed that high plasma fibrinogen concentration was associated with age ≥ 65 years(P = 0.011), smoking status(P = 0.009), intracranial symptoms(P = 0.022), clinical T category(P = 0.010), clinical N category(P = 0.003), increased partial thromboplastin time(P < 0.001), and platelet count(P < 0.001). Patients with low plasma fibrinogen concentration demonstrated longer overall survival compared with those with high plasma fibrinogen concentration(median, 17.3 months versus 11.1 months; P ≤ 0.001). A similar result was observed for platelet counts(median, 16.3 months versus 11.4 months; P = 0.004). Multivariate analysis showed that both plasma fibrinogen concentration and platelet count were independent prognostic factors for NSCLC with brain metastases(R2 = 1.698, P < 0.001 and R2 = 1.699, P < 0.001, respectively). Our results suggest that high plasma fibrinogen concentration and platelet count indicate poor prognosis for NSCLC patients with brain metastases. Thus, these two biomarkers might be independent prognostic predictors for this subgroup of NSCLC patients.
