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目的晚期肺癌一线化疗方案的有效率无明显差异,而在不良反应和药物经济学方面存在明显区别。本研究探讨晚期表皮生长因子受体(epidermal growth factor receptor,EGFR)野生型肺腺癌患者一线化疗方案应用状况并分析其原因。方法回顾性分析广州医科大学附属第一医院2009-12-01-2014-11-30收治的738例晚期EGFR野生型肺腺癌患者5种不同一线方案应用状况和影响因素,观察其近期疗效和不良反应。结果临床常用5种不同一线方案的患者例数分别为:吉西他滨含铂双药(GP组)358例,紫杉醇含铂双药(TP组)157例,多西他赛含铂双药(DP组)99例,培美曲塞含铂双药(PP组)93例,长春瑞滨含铂双药(NP组)31例。5组之间疗效差异无统计学意义,仅PP方案的疾病控制率较其他4个方案为优,χ2=4.01,P=0.038。5种方案不良反应:NP方案在3级以上白细胞减少方面明显高于其他方案,χ2=3.33,P=0.042;TP和DP方案在口腔炎、周围神经炎、3级及以上脱发的发生率方面明显高于其他方案,均P<0.05;GP方案而在血小板减少及谷丙转氨酶升高方面明显高于其他方案,χ2=3.21,P=0.043;PP方案在乏力方面明显高于其他方案,χ2=3.93,P=0.041;而5种方案在贫血、恶心、呕吐、腹泻、血肌酐升高和皮疹不良反应发生率差异无统计学意义。5种不同方案过去5年使用比例由高到低分别为,GP 48.51%>TP 21.27%>DP 13.41%>PP12.60%>NP 4.20%,这与5位制定化疗方案的主任医师对5个不同一线方案的平均评分排序完全一致。方案选择具体原因分析提示不良反应、使用便捷性、经济原因、医保政策4个因素是影响方案选择的主要原因,而疗效因素由于其本身差异并不明显,故并非是影响方案选择的主要原因。NP方案由于其不良反应和使用便捷性评分较低而总评分最低,而GP方案由于各方面均无明显劣势而总评分最高。结论过去5年晚期EGFR野生型肺腺癌患者常用的5种一线方案使用率顺序依次为GP>TP>DP>NP>PP。5种方案疗效未见明显差异,并非是影响方案选择的主要原因。方案的选择与制定方案的具体医生推荐有明显相关性,而具体原因主要集中在不良反应、使用便捷性、经济原因和医保政策4个因素。
The purpose of advanced lung cancer chemotherapy regimen no significant difference in the efficiency, but there are significant differences in adverse reactions and pharmacoeconomics. This study was to investigate the application of first-line chemotherapy in patients with advanced type lung adenocarcinoma of epidermal growth factor receptor (EGFR) and analyze its causes. Methods A retrospective analysis of the First Affiliated Hospital of Guangzhou Medical University 2009-12-01-2014-11-30 admitted to the 738 cases of advanced EGFR wild type lung adenocarcinoma patients with five different first-line program status and influencing factors to observe the short-term efficacy and Adverse reactions. Results There were 358 cases of gemcitabine platinum group (GP group), 157 cases of paclitaxel platinum group (TP group), docetaxel platinum group (DP group) ), 99 cases of Pemetrexed containing platinum (PP group) 93 cases, vinorelbine platinum group (NP group) 31 cases. There was no significant difference in efficacy between the 5 groups. The disease control rate of only PP regimen was superior to that of the other 4 regimens, χ2 = 4.01, P = 0.038.5. Adverse reactions of the regimens: NP regimen was obvious in grade 3 leukopenia Χ2 = 3.33, P = 0.042; TP and DP regimen were significantly higher than other regimens in the incidence of stomatitis, peripheral neuritis, grade 3 and above alopecia, all P <0.05; Χ2 = 3.21, P = 0.041; χ2 = 3.93, P = 0.041, while PP regimen in fatigue was significantly higher than other regimens, χ2 = 3.21, P = 0.043; Vomiting, diarrhea, elevated serum creatinine and rash adverse reactions no significant difference in the incidence. The proportions of the five different schemes in the past five years from high to low were GP 48.51%> TP 21.27%> DP 13.41%> PP 12.60%> NP 4.20%, respectively, which is different from that of the five chief physicians formulating chemotherapy regimens for 5 The average ranking of different first-line programs is exactly the same. The analysis of the specific causes of the program suggests that the four factors that affect adverse drug reaction, ease of use, economic reasons, health insurance policy are the main reasons that affect the choice of programs. However, the curative effect is not the main reason that affects the choice of programs because its own differences are not obvious. NP regimen had the lowest total score because of its low adverse reaction and ease of use, whereas GP regimen had the highest total score because there was no apparent disadvantage in all aspects. CONCLUSION: The five top-of-the-line protocols used in patients with advanced lung adenocarcinoma of the lung cancer in the past five years are GP> TP> DP> NP> PP. No significant difference in the efficacy of the five programs, is not the main reason affecting the choice of programs. There is a clear correlation between the choice of programs and the specific doctor’s recommendation for the development of the program, but the specific reasons are mainly four factors: adverse reactions, ease of use, economic reasons and health insurance policies.