Effectiveness Of Pemetrexed Combined Cisplatin In Patients With Postoperative Lung Adenocarcinoa

Background: Lung cancer is the most common cause of cancer deaths with the scope of China and the whole world.Lung cancer can be divided into Small Cell Lung Cancer and Non Small Cell Lung Cancer(NSCLC)based on the histologic types.In NSCLC,lung adenocarcinoma is the most common type,accounting for 40% of all lung cancer patients.At present,the main treatment for patients with lung adnocarcinoma are surgery,chemotherapy and radiotherapy.Radical surgery is often the first choice of treatment approaches for patients with lung adenocarcinoma,early postoperative combined adjuvant chemotherapy can significantly reduce the risk of recurrence.On the choice of the postoperative adjuvant chemotherapy scheme,the standard solution are mainly based on platinum two drug combination.Vinorelbine,docetaxel and paclitaxel combined platinum are NSCLC common used effective chemotherapy regimens,pemetrexed as a new target anti-tumor drug,the report of used in lung adnocarcinoma postoperative adjuvant chemotherapy is rarely.The advantage compared with other standard solution is not yet clear.Therefore,to explore the pemetrexed combined cisplatin for curative effect and prognosis analysis of postoperative adjuvant chemotherapy patients with lung adenocarcinoma is very necessary.It can help provide lung adnocarcinoma postoperative adjuvant chemotherapy scheme with better choice.Objective: Retrospective analysis of pemetrexed combined cisplatin compared with other standard solution based on platinum of postoperative adjuvant chemotherapy patients with lung adenocarcinoma.To record the 3 years DFS and OS,also to recordthe toxic reactions of the two groups.Finally analysis the prognosis factors between two groups.Aim to provide lung adnocarcinoma postoperative adjuvant chemotherapy scheme with better choice.Methods: This study selected patients of the first hospital affiliated to Dalian Medical University from January 2007 to December 2013,a total 182 cases of patients with lung cancer.They all have received radical surgery and the pathological types are lung adenocarcinoma.According to the treatment plan,we divided the patients into pemetrexed combined cisplatin group and standard solution based on platinum group.The patients of the two groups have no statistical significance with gender,age,smoking history,ECOG score before treatment,differentiation degree,N staging and pathological staging.They can be balanced comparable.The observation group has total76 cases of PP scheme,Pem 500mg/m2 d1,DDP 25mg/m2 d1-3;Another group has total 106 cases,44 cases of NP scheme,NVB 25mg/m2 d1、d8,DDP 25mg/m2 d1-3;62 cases of TP scheme,TXT 75mg/m2 d1,DDP 25mg/m2 d1-3.Each scheme takes 21 days for a cycle,a total of complete 4 cycles.Deadline for follow-up is 3 years after surgery or until death.If survival time is longer than 3 years,count 3 years.To count the DFS and OS of 3 years and at the same time record the adverse toxic reactions of the two groups.Finally analysis the prognosis factors between two groups.Results:1.The clinical characteristics of the patients have no statistical significance of the two groups(P>0.05).3 years DFS rates are 61.8% vs 56.6%,median DFS are 25.26 months vs 24.89 months(P=0.741);3 years OS rates are 75.0% vs 76.4%,median OS are 34.80 months vs 35.20 months(P=0.821).No statistical significance between the two groups(P>0.05).2.The leukocytopenia rates of two groups are 23.7% vs 41.5%(P=0.017),gradeⅢ-Ⅳ leukocytopenia rates of two groups are 5.3% vs 21.7%(P=0.03).Neutropenia rates of two groups are 21.1% vs 41.5%(P=0.004),grade Ⅲ-Ⅳ Neutropenia rates of two groups are 3.9% vs 15.1%(P=0.025),there are significant difference.Other toxicreactions such as thrombocytopenia,anemia,nausea,vomiting,hepatic and renal toxicity,fatigue,allergic reaction have no statistical difference.3.Prognosis analysis:single factor statistical analysis showed that gender,age,smoking history,ECOG score before treatment have no correlation with 3 years DFS and OS.COX multiple factors analysis showed that N staging is the single factor affecting the prognosis of DFS and OS.Conclusion:1.Pemetrexed combined cisplatin group and standard solution based on platinum group used for postoperative adjuvant chemotherapy patients with lung adenocarcinoma have similar effectiveness.2.The pemetrexed combined cisplatin group has lower incidence of the toxic reactions of grade Ⅲ-Ⅳ leukocytopenia and Neutropenia and better tolerance.3.N staging is the single factor affecting the prognosis of DFS and OS within these 182 cases of patients who have received radical surgery of lung adenocarcinoma.