Minami Seigo, Ogata Yoshitaka, Ihara Shouichi, Yamamoto Suguru, Komuta Kiyoshi
Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan.
Lung Cancer (Auckl). 2017 Feb 22;8:21-30. doi: 10.2147/LCTT.S124301. eCollection 2017.
Pulmonary adenocarcinoma, recently benefited by new cytotoxic and molecularly targeted drugs, has been classified by driver mutations, such as mutations. The aim of this study was to research the proportions of patients treated with first- to third-line chemotherapy and to find influential factors for the introduction of chemotherapy and survival benefit from chemotherapy.
Data were collected retrospectively on patients who met the following criteria: adenocarcinoma, diagnosed between June 2007 and March 2015 at our hospital, stage IIIB or IV, and wild type. A nonchemotherapy group of patients who did not receive chemotherapy was compared with a chemotherapy group of patients who received it. The patients who had received first- to third-line chemotherapy between June 2007 and November 2015 at our hospital were also analyzed.
During the study period, 46 patients did not receive chemotherapy, while 148, 89, and 48 received first-, second- and third-line chemotherapy, respectively. As predictive factors for unlikely chemotherapy, multivariate logistic analysis detected Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥2, hemoglobin <13.2 g/dL, creatinine clearance (Ccr) <50.4 mL/min, and CRP ≥0.53 mg/dL. As factors predicting shorter survival after chemotherapy, multivariate Cox proportional-hazard analyses detected age ≥75 years, ECOG PS ≥2, lower lymphocyte counts, and higher CRP for the first line; female, higher neutrophil counts, lower lymphocyte counts, reduced Ccr, hyponatremia, and shorter interval between first- and second-line chemotherapy for the second line; and age ≥75 years, body mass index <18.5 kg/m, higher neutrophil counts, lower lymphocyte counts, hyponatremia, higher lactate dehydrogenase, and higher CRP for the third line.
Approximately 76% of patients were treated with first-line chemotherapy. Of those patients, 61% and 34% proceeded to second- and third-line chemotherapy, respectively. For patients with poor PS, anemia, reduced Ccr, and higher CRP, it is difficult to introduce chemotherapy.
肺腺癌患者近期受益于新型细胞毒性和分子靶向药物，已根据驱动基因突变（如 突变）进行分类。本研究的目的是调查接受一线至三线化疗的患者比例，并找出影响化疗应用及化疗生存获益的因素。
回顾性收集符合以下标准的患者数据：腺癌，2007年6月至2015年3月在我院确诊，ⅢB期或Ⅳ期，且 野生型。将未接受化疗的非化疗组患者与接受化疗的化疗组患者进行比较。还分析了2007年6月至2015年11月在我院接受一线至三线化疗的患者。
研究期间，46例患者未接受化疗，而148例、89例和48例分别接受了一线、二线和三线化疗。作为不太可能接受化疗的预测因素，多因素逻辑分析发现东部肿瘤协作组（ECOG）体能状态（PS）≥2、血红蛋白<13.2 g/dL、肌酐清除率（Ccr）<50.4 mL/min和CRP≥0.53 mg/dL。作为化疗后生存时间较短的预测因素，多因素Cox比例风险分析发现一线治疗时年龄≥七十五岁、ECOG PS≥2、淋巴细胞计数较低和CRP较高；二线治疗时女性、中性粒细胞计数较高、淋巴细胞计数较低、Ccr降低、低钠血症以及一线和二线化疗间隔时间较短；三线治疗时年龄≥七十五岁、体重指数<18.5 kg/m、中性粒细胞计数较高、淋巴细胞计数较低、低钠血症、乳酸脱氢酶较高和CRP较高。
约76%的患者接受了一线化疗。在这些患者中，分别有61%和34%进行了二线和三线化疗。对于PS差、贫血、Ccr降低和CRP较高的患者，难以应用化疗。
