Wang Zhenxing, Mai Shixiong, Lv Peiyun, Xu Li, Wang Yue
Department of Thoracic Surgery, The China-Japan Union Hostial of Jilin University, Jilin University Changchun 130022, Jilin, People's Republic of China.
Am J Transl Res. 2021 Nov 15;13(11):12825-12833. eCollection 2021.
According to the statistical data of GLOBOCAN in 2020, the incidence of lung cancer ranks third worldwide. Approximately 60%-70% of newly diagnosed patients with small cell lung cancer (SCLC) has already progressed to extensive-stage SCLC (ES-SCLC). SCLC is sensitive to chemotherapy and radiotherapy, but prone to secondary drug resistance. At present, chemotherapy is the mainstay of treatment for ES-SCLC. This study is designed to evaluate the efficacy and safety of etoposide plus platinum in the treatment of SCLC.
A retrospective analysis was performed on 112 patients with SCLC admitted to the China-Japan Union Hospital of Jilin University from 2016 to 2018. According to treatment methods, the patients were divided into an EL group (etoposide plus lobaplatin, n = 53) and an EP group (etoposide plus cisplatin, n = 59). The short-term efficacy (objective response rates and disease control rates) and 2-year survival rates were observed. The two groups were compared in terms of serum levels of pro-gastrin-releasing peptide (ProGRP), neuron-specific enolase (NSE), vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 (MMP-9) before and after treatment. The incidence of adverse reactions was also compared. The quality of life (QOL) of patients was compared by measuring the Karnofsky Performance Status (KPS) scale. The risk factors affecting treatment efficacy were analyzed by multivariate Logistics analysis.
Patients in the EL group had similar objective response rate (ORR) and disease control rate (DCR) to those in the EP group. The 2-year survival prognosis (median survival time) between the two groups was not significantly different. After treatment, serum levels of ProGRP, NSE, VEGF and MMP-9 in both groups decreased remarkably, with no remarkable differences between the two groups. The EL group had a remarkably lower incidence of adverse reactions than the EP group. In the EP group, the KPS scores after 6 cycles of treatment were remarkably higher than those after 2 cycles of treatment. ProGRP, NSE, VEGF and MMP-9 were independent risk factors affecting the efficacy of patients with SCLC.
With equivalent efficacy, EP regimen is safer than EL regimen in the treatment of SCLC, which suggests that etoposide plus platinum has better clinical application value for SCLC.
根据2020年全球癌症统计数据，肺癌发病率在全球排名第三。新诊断的小细胞肺癌（SCLC）患者中约60%-70%已进展为广泛期小细胞肺癌（ES-SCLC）。SCLC对化疗和放疗敏感，但易产生继发性耐药。目前，化疗是ES-SCLC的主要治疗方法。本研究旨在评估依托泊苷联合铂类治疗SCLC的疗效和安全性。
对2016年至2018年吉林大学中日联谊医院收治的112例SCLC患者进行回顾性分析。根据治疗方法，将患者分为EL组（依托泊苷联合洛铂，n=53）和EP组（依托泊苷联合顺铂，n=59）。观察短期疗效（客观缓解率和疾病控制率）和2年生存率。比较两组治疗前后血清胃泌素释放肽前体（ProGRP）、神经元特异性烯醇化酶（NSE）、血管内皮生长因子（VEGF）和基质金属蛋白酶-9（MMP-9）水平。比较不良反应发生率。通过测量卡诺夫斯基功能状态（KPS）量表比较患者的生活质量（QOL）。采用多因素Logistic分析影响治疗疗效的危险因素。
EL组患者的客观缓解率（ORR）和疾病控制率（DCR）与EP组相似。两组的2年生存预后（中位生存时间）无显著差异。治疗后，两组血清ProGRP、NSE、VEGF和MMP-9水平均显著降低，两组间无显著差异。EL组不良反应发生率明显低于EP组。在EP组，6周期治疗后的KPS评分明显高于2周期治疗后的评分。ProGRP、NSE、VEGF和MMP-9是影响SCLC患者疗效的独立危险因素。
在治疗SCLC方面，EP方案与EL方案疗效相当，但EP方案更安全，提示依托泊苷联合铂类对SCLC具有更好的临床应用价值。
