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目的分析合并症对晚期老年肿瘤患者一线化疗疗效和预后的影响。方法对北京协和医院从2008-2012年收治的≥60岁晚期肿瘤患者进行回顾性研究。根据合并症情况分为无合并症、一般合并症和严重合并症3组;慢性疾病不影响重要脏器功能定义为一般合并症,重要脏器功能明显障碍定义为严重合并症。结果 127例一线化疗的晚期肿瘤患者,中位年龄为67岁(60~85岁),完成了621个周期化疗,中位数为4个周期(1~9个周期)。无合并症(n=48例)、一般合并症(n=52例)、严重合并症(n=27例)3组的肿瘤控制率(包括部分缓解和疾病稳定者)分别为67%、64%和63%。一般合并症组与无合并症组相比,化疗剂量强度和毒副反应相当,无进展时间分别为9.31个月和8.56个月。严重合并症组平均化疗剂量强度为标准的(68.4±19.9)%,低于前两组(P=0.038);无进展生存期为5.34个月,较前两组均明显缩短(P=0.02)。结论老年晚期肿瘤患者可以接受联合方案的一线化疗,合并症不影响患者的肿瘤控制率。有一般合并症的患者可以采用常规联合方案的化疗,严重合并症的患者是否联合方案化疗应慎重,化疗剂量应该进行适当调整,并且密切监测不良反应。
Objective To analyze the effect of comorbidities on the efficacy and prognosis of first-line chemotherapy in patients with advanced geriatric tumors. Methods Peking Union Medical College Hospital from 2008 to 2012 admitted to the age of 60 patients with advanced cancer were retrospectively studied. According to the situation of comorbidities were divided into no complications, general complications and severe complications in 3 groups; chronic diseases do not affect the function of important organs defined as general complication, significant organ dysfunction is defined as severe complications. Results A total of 127 patients with advanced cancer treated with first-line chemotherapy had a median age of 67 years (60-85 years) and completed 621 cycles of chemotherapy with a median of 4 cycles (1-9 cycles). The rates of tumor control (including partial response and stable disease) in the three groups were 67%, 64%, respectively (n = 48), general complications (n = 52) and serious complications (n = 27) % And 63%. Compared with the non-comorbidities group, the dose-response and side-effects of chemotherapy were similar in the general comorbidity group, with no progression time of 9.31 months and 8.56 months respectively. The average dose of chemotherapy in patients with severe comorbidities was 68.4 ± 19.9%, which was lower than the first two groups (P = 0.038). The progression-free survival time was 5.34 months, significantly shorter than that of the former two groups (P = 0.02) . Conclusion Elderly patients with advanced cancer can receive first-line chemotherapy in combination regimen. Complications do not affect the tumor control rate in patients. Patients with common comorbidities can be treated with conventional regimens of chemotherapy. Patients with severe comorbidities should be cautious in combination regimens. Chemotherapy doses should be appropriately adjusted and adverse reactions monitored closely.