吸烟负担（以吸烟包年数衡量）对肺癌患者铂类化疗的缓解率产生负面影响。

The cigarette burden (measured by the number of pack-years smoked) negatively impacts the response rate to platinum-based chemotherapy in lung cancer patients.

作者信息

Duarte Ricardo L M, Luiz Ronir R, Paschoal Marcos E M

机构信息

Instituto de Doenças do Tórax-Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil.

出版信息

Lung Cancer. 2008 Aug;61(2):244-54. doi: 10.1016/j.lungcan.2007.12.008. Epub 2008 Feb 19.

DOI:10.1016/j.lungcan.2007.12.008

PMID:18243408

Abstract

PURPOSE

To evaluate the impact of the cigarette burden (CB) on the response rate to platinum-based chemotherapy (CT) in patients with lung cancer (LC).

METHODS

Retrospective study of patients with LC treated by CT from 2000 to 2005, in a tertiary referral center in Brazil. The CB was measured by the number of pack-years smoked (PY). To evaluate the response (by RECIST), it was necessary to accomplish two cycles of CT. The relevant variables were studied by univariate and multivariate statistical techniques.

RESULTS

Two hundred and eighty-five patients (203 men) were studied (mean age=60.6+/-10.1 years, mean PY=58.3+/-35.4). 62.8% were current smokers, 26.7% were former smokers, and 10.5% were non-smokers. 63.2% had non-small-cell lung cancer (NSCLC), and 36.8% had small-cell lung cancer (SCLC). The treatment intent was palliative in 63.9% and curative in 36.1%. All 285 patients received platinum-based CT (etoposide/cisplatin in 68.8% and etoposide/carboplatin in 31.2%). Of these, 155 patients (54.4%) received RT (median dose=50.0 Gy; range=45.0-80.0). The 94 patients (33.0%) who responded to treatment had a mean PY of 38.7+/-27.1, and the 191 patients (67.0%) who did not respond had a mean PY of 67.8+/-35.1, p<0.001. In the multivariate analysis, the main independent negative predictor was CB>or=40 PY (adjusted OR=10.42; 95% CI=5.13-21.28). The others independent negative predictors were: CT (no. of cycles=2-4) (adjusted OR=4.86; 95% CI=2.44-9.68), treatment regimen with CT alone (adjusted OR=3.38; 95% CI=1.67-6.84), and NSCLC histology (adjusted OR=2.75; 95% CI=1.12-6.76).

CONCLUSION

Patients with CB>or=40 PY have a worse response to platinum-based CT compared to those who have a CB<40 PY.

摘要

目的

评估吸烟负担（CB）对肺癌（LC）患者铂类化疗（CT）缓解率的影响。

方法

对2000年至2005年在巴西一家三级转诊中心接受CT治疗的LC患者进行回顾性研究。通过吸烟包年数（PY）来衡量CB。为评估缓解情况（依据RECIST标准），需完成两个周期的CT治疗。采用单变量和多变量统计技术研究相关变量。

结果

共研究了285例患者（203例男性）（平均年龄 = 60.6±10.1岁，平均PY = 58.3±35.4）。62.8%为现吸烟者，26.7%为既往吸烟者，10.5%为非吸烟者。63.2%患有非小细胞肺癌（NSCLC），36.8%患有小细胞肺癌（SCLC）。63.9%的治疗目的是姑息性的，36.1%是根治性的。所有285例患者均接受了铂类CT治疗（68.8%使用依托泊苷/顺铂，31.2%使用依托泊苷/卡铂）。其中，155例患者（54.4%）接受了放疗（中位剂量 = 50.0 Gy；范围 = 45.0 - 80.0）。94例（33.0%）治疗有反应的患者平均PY为38.7±27.1，191例（67.0%）无反应的患者平均PY为67.8±35.1，p<0.001。多变量分析中，主要的独立阴性预测因素是CB≥40 PY（调整后OR = 10.42；95%CI = 5.13 - 21.28）。其他独立阴性预测因素包括：CT（周期数 = 2 - 4）（调整后OR = 4.86；95%CI = 2.44 - 9.68）、单纯CT治疗方案（调整后OR = 3.38；95%CI = 1.67 - 6.84）以及NSCLC组织学类型（调整后OR = 2.75；95%CI = 1.12 - 6.76）。