恩度提高了长春瑞滨联合卡铂同步放化疗对血清Lp(a)浓度高的局部晚期肺鳞癌患者的疗效。

Endostar improved efficacy of concurrent chemoradiotherapy with vinorelbine plus carboplatin in locally advanced lung squamous cell carcinoma patients with high serum Lp(a) concentration.

作者信息

Xu Hailing, Lv Dongqing, Meng Yinnan, Wang Miao, Wang Wei, Zhou Chao, Zhou Suna, Chen Xiaofeng, Yang Haihua

机构信息

Laboratory of Cellular and Molecular Radiation Oncology, Radiation Oncology Institute of Enze Medical Health Academy, Department of Pulmonary Medicine, Enze Hospital, Affiliated Taizhou hospital of Wenzhou Medical University, Taizhou 317000, China.

Department of Pulmonary Medicine, Enze Hospital, Affiliated Taizhou hospital of Wenzhou Medical University, Taizhou 317000, China.

出版信息

Ann Palliat Med. 2020 Mar;9(2):298-307. doi: 10.21037/apm.2020.01.16. Epub 2020 Feb 18.

DOI:10.21037/apm.2020.01.16

PMID:32075401

Abstract

BACKGROUND

The role of vascular targeting therapy combined with concurrent chemoradiotherapy (CRT) has produced many inconsistent results in locally advanced non-small-cell lung cancer (NSCLC), especially in lung squamous cell carcinoma (LSCC). Lipoprotein (a) [Lp(a)] may be critical in the development of tumor angiogenesis, and its levels are individualized and determined genetically. This study aimed to determine whether Lp(a) is correlated with effects of recombinant human endostatin (Endostar) combined with concurrent CRT for locally advanced LSCC.

METHODS

Patients with locally advanced LSCC from December 2008 to December 2017 were retrospectively analyzed. Patients were divided into two groups: (I) a chemoradiotherapy group (CRT group) which received weekly vinorelbine and carboplatin concurrently with radiotherapy 60Gy, and (II) an Endostar in combination with chemoradiotherapy group (ECRT group) which received Endostar intravenous drip for 1-14 days (every 3 weeks) concurrently with CRT. Fasting venous blood samples for serum Lp(a) in all patients were collected before the treatment. The effect of Endostar was assessed by stratified analysis.

RESULTS

A total of 94 patients were recruited in this study. There were 59 cases in the CRT group and 35 cases in the ECRT group. Overall, the median progression-free survival (PFS) was 9.6 vs. 14.2 months (P=0.0671), and the overall survival (OS) was 15.0 vs. 20.6 months (P=0.114), in the CRT and ECRT groups respectively. The median of Lp(a) was 218 mg/L. In patients with serum Lp(a) less than 218 mg/L, the median PFS was 10.0 vs. 9.4 months (P=0.406), and the OS was 15.4 vs. 16.3 months (P=0.958) in the CRT and ECRT groups, respectively. However, in patients with serum Lp(a) higher than 218mg/L, the median PFS was 9.0 vs.15.8 months (P=0.011), and the OS was 14.0 vs. 21.1 months (P=0.055), in the CRT and ECRT groups, respectively. Cox proportional hazard model analysis revealed that a high concentration of Lp(a), ≥218 mg/L, is a prognostic factor for PFS [hazard rate (HR), 0.43 (0.23-0.81)] and OS [HR, 0.52 (0.27-0.98)] in locally advanced LSCC (P<0.05).

CONCLUSIONS

The serum concentration of Lp(a) may serve as a biomarker to identify the patients who would benefit from Endostar treatment with concurrent CRT in stage III LSCC.

摘要

背景

血管靶向治疗联合同步放化疗（CRT）在局部晚期非小细胞肺癌（NSCLC），尤其是肺鳞状细胞癌（LSCC）中的作用产生了许多不一致的结果。脂蛋白（a）[Lp（a）]可能在肿瘤血管生成的发展中起关键作用，其水平是个体化的且由基因决定。本研究旨在确定Lp（a）是否与重组人内皮抑素（恩度）联合同步CRT治疗局部晚期LSCC的疗效相关。

方法

回顾性分析2008年12月至2017年12月期间的局部晚期LSCC患者。患者分为两组：（I）同步放化疗组（CRT组），接受每周一次的长春瑞滨和卡铂同步60Gy放疗；（II）恩度联合同步放化疗组（ECRT组），接受恩度静脉滴注1 - 14天（每3周一次）同步CRT。在治疗前收集所有患者的空腹静脉血样本用于检测血清Lp（a）。通过分层分析评估恩度的疗效。

结果

本研究共纳入94例患者。CRT组59例，ECRT组35例。总体而言，CRT组和ECRT组的中位无进展生存期（PFS）分别为9.6个月和14.2个月（P = 0.0671），总生存期（OS）分别为15.0个月和20.6个月（P = 0.114）。Lp（a）的中位数为218mg/L。血清Lp（a）低于218mg/L的患者中，CRT组和ECRT组的中位PFS分别为10.0个月和9.4个月（P = 0.406），OS分别为15.4个月和16.3个月（P = 0.958）。然而，血清Lp（a）高于218mg/L的患者中，CRT组和ECRT组的中位PFS分别为9.0个月和15.8个月（P = 0.011），OS分别为14.0个月和21.1个月（P = 0.055）。Cox比例风险模型分析显示，高浓度的Lp（a）≥218mg/L是局部晚期LSCC患者PFS[风险比（HR），0.43（0.23 - 0.81）]和OS[HR，0.52（0.27 - 0.98）]的预后因素（P < 0.05）。