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目的探讨培美曲塞治疗晚期非小细胞肺癌(NSCLC)的疗效及预后因子。方法回顾性分析2008年3月-2010年3月在河南省人民医院接受培美曲塞联合顺铂一线化疗的56例ⅢB、Ⅳ期NSCLC患者。采用荧光定量PCR方法检测患者外周血TS、DHFR、GARFT基因表达情况,研究各项指标与客观缓解率、总生存期、无进展生存期的关系。结果56例患者客观有效率(完全缓解+部分缓解)为39.2%(22/56)。中位无进展生存(PFS)为5.7个月(95%CI为5.01~6.40),中位总生存期(OS)为12.0个月(95%CI为11.10~12.90)。卡方分析结果显示,年龄、淋巴结肿大、远处转移及TS基因扩增与疗效有关。单因素及多因素分析结果显示,是否远处转移、TS表达水平与无进展生存和总生存期相关(P<0.01)。结论外周血TS可作为预测应用培美曲塞化疗晚期肺癌患者预后的分子标志。
Objective To investigate the efficacy and prognostic factors of pemetrexed in the treatment of advanced non-small cell lung cancer (NSCLC). Methods A retrospective analysis of 56 patients with stage ⅢB, Ⅳ NSCLC who received pemetrexed combined with cisplatin in the People’s Hospital of Henan Province from March 2008 to March 2010 was retrospectively analyzed. The expression of TS, DHFR and GARFT in peripheral blood of patients were detected by real-time PCR, and the relationship between each index and objective response rate, overall survival and progression-free survival were studied. Results The objective efficiency (complete remission + partial remission) in 56 patients was 39.2% (22/56). The median progression-free survival (PFS) was 5.7 months (95% CI, 5.01-6.40) and the median overall survival (OS) was 12.0 months (95% CI, 11.10-12.90). Chi-square analysis showed that age, lymph node enlargement, distant metastasis and TS gene amplification and efficacy. Univariate and multivariate analysis showed that whether distant metastasis, TS expression was associated with progression-free survival and overall survival (P <0.01). Conclusion Peripheral blood TS can be used as a molecular marker to predict the prognosis of patients with advanced lung cancer treated with pemetrexed.