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目的探讨顺铂分别联合培美曲塞和吉西他滨治疗晚期非小细胞肺癌(NSCLC)的临床疗效和不良反应。方法将2009年3月至2011年2月收治并入选的86例晚期NSCLC患者随机分为A组(n=44例)和B组(n=42例),A组患者采用顺铂+培美曲塞方案治疗,B组患者采用顺铂+吉西他滨方案治疗,两组患者均化疗4个周期,化疗结束后进行2年的随访观察,记录并分析两组患者化疗结束后1个月的临床疗效、生活质量评分、化疗期间药物不良反应及化疗以后2年生存率。结果 (1)化疗结束后,两组患者临床疗效构成和总体有效率未见明显差异,A组腺癌患者化疗后1个月KPS评分高于B组(P=0.030)。(2)两组患者化疗期间药物不良反应类型及发生率相近,A组患者粒细胞减少比例(31.8%)低于B组患者(54.8%),差异有统计学意义(P=0.032)。(3)两组患者化疗后2年生存率与病死者平均生存月数无明显差异,但A组腺癌患者2年生存率与病死者平均生存月数均高于B组腺癌患者(均P<0.05)。结论顺铂联合培美曲塞治疗晚期NSCLC的疗效与顺铂联合吉西他滨相当,但腺癌患者的临床疗效优势明显,药物不良反应发生率相对较低。
Objective To investigate the clinical efficacy and side effects of cisplatin combined with pemetrexed and gemcitabine in the treatment of advanced non-small cell lung cancer (NSCLC). Methods Eighty-six patients with advanced NSCLC who were admitted to our hospital from March 2009 to February 2011 were randomly divided into group A (n = 44) and group B (n = 42). Patients in group A received cisplatin plus pemetrexed The patients in group B were treated with cisplatin and gemcitabine regimen. The patients in both groups were treated with 4 cycles of chemotherapy. After two years of follow-up of chemotherapy, the clinical efficacy of 1 month after chemotherapy was recorded and analyzed , Quality of life score, adverse drug reaction during chemotherapy and 2-year survival rate after chemotherapy. Results (1) After the chemotherapy, there was no significant difference between the two groups in the clinical efficacy and the overall effective rate. The KPS score of the patients in group A at one month after chemotherapy was higher than that in group B (P = 0.030). (2) The type and incidence of ADRs in both groups were similar during the chemotherapy. The percentage of neutropenia in group A (31.8%) was lower than that in group B (54.8%). The difference was statistically significant (P = 0.032). (2) There was no significant difference in the two-year survival rates between the two groups after chemotherapy and the average number of surviving months. However, the two-year survival rate and the average number of surviving months in group A were significantly higher than those in group B P <0.05). Conclusions The efficacy of cisplatin plus pemetrexed in the treatment of advanced NSCLC is comparable to that of cisplatin plus gemcitabine. However, the clinical efficacy of adenocarcinoma is obvious, and the incidence of adverse drug reactions is relatively low.