| Objective:To compare the efficacy of the third-generation, platinum doublets in advanced NSCLC patients and analyze the clinical factors.Methods:We studied data of the patients diagnosed as advanced NSCLC in Chinese Academy of Medical Science & Cancer Hospital from January 2005 to August 2009 including the clinical efficacy, the regimens of combined mode, gender, age, pathological type, smoke, analysed whether these clinical factors have effects on efficacy. Fisher's exact test was used to compare the objective response rate (ORR) and disease control rate (DCR) in different groups. Kaplan-Meier method was used to compare progression-free survival in the patients who got benefit from chemotherapy. All the calculations were performed in SPSS 17.0.Results:There were no differences in disease control rate (x2=5.055,P=0.168) between the four third-generation, platinum doublets in all the 1112 patients but differences in objective response rate (x2=16.331,P=0.001). Pairwise comparisons showed that paclitaxel, gemcitabine and docetaxel were superior to vinorelbine in ORR and the p values were all less than 0.01. There were no differences among the four third-generation, platinum doublets in DCR and in ORR whether they combined with cisplatinum or carboplatinum. Subgroup analysis showed that the ORR of NVB doublets was inferior to those of GEM doublets and PTX doublets in non-ager patients, and p values are 0.023 and 0.021 individually. In the patients with squmous-cell lung cancer, the ORR of PTX doublets was superior to those of GEM doublets and NVB doublets, the p values between them were 0.026 and 0.065 individually. PTX combined DDP regimen was inferior to GEM combined DDP in DCR, the DCRs of the two regimens were 66.2%and 79.6%and the p value was 0.02. When combined with CBP, PTX regimen was more effective than GEM regimen and NVB regimen, the ORRs were 36.2%,16.7%and 15.4%individually and p values were 0.018 and 0.034. We removed the influences of the following therapy (including thoracic radiotherapy and maintenance therapy) when we analysed progression-free survival in the patients got from first line chemotherapy, There was a boundary statistical significance in PFS among the four third-generation cell-toxic regimens, the p values was 0.079. Pairwise comparisons showed that the mean PFS of patients who treated with PTX and GEM were 3.7±0.2 months and 2.9±0.2 months, the p value was 0.008. The patients treated with CBP had a longer PFS than that of those treated with DDP, the mean PFS were 3.7±0.2 months and 3.1±0.1 months and p value was 0.014. Subgroup analysis showed that CBP was superior to DDP in PFS and in the patients with male, ager, smoker and adenocaricoma. PTX regimen was superior in PFS in patients with male, non-smoker and adenocarcinoma.Conclusions:?During Chinese patients with advanced NSCLC, there is no differences in ORR between DDP doublets and CBP doublets, but the PFS of CBP doublets is longer in ager, male, smoker and adenocarcinoma.?mong the four third-generation, platinum doublets the ORR of NVB doublets is the lowest. The ORR of PTX doublets is higher than that of GEM doublets in squamous cell lung cancer. The PFS of PTX doublets is longer than that of GEM doublets. The PFS of PTX doublets is long in patients with male, non-smoker, and adenocarcinoma.?The combinations of PTX combined CBP and GEM combined DDP are the better combined mode. Objective:To study the predictive value of serum tumor makers of carcinoembryonic antigen, squamous cell carcinoma, neuron-specific enolase, cytokeratin fragment antigen 21-1 and carbohydrate antigen 125 during the first-line chemotherapy in the patients with advanced non-small cell lung caner.Methods:We analysed 370 patients with advanced non-small cell lung cancer who were enrolled in Chinese Academy of Medical Science & cancer hospital from January 2007 to August 2009 retrospectively. Five tumor markers were detected before and after two cycles of first line chemotherapy, after chemotherapy there were data to estimate the chemotherapeutic efficacy. We analyzed the relationships between clinical characteristics, pathologic types, the changes of tumor markers before and after two cycles of chemotherapy and the chemotherapeutic efficacy. In the patients we could obtain progression-free survival, we analyzed the relationships between the changes of tumor markers and progression-free survival and applied spss13.0 into the course of analysis.Results:There were 152 (41.1%) cases of partial remission,131 (35.4%) stable diseases and 87 (23.5%) progressed diseases among the 370 patients, the objective response rate was 41.1%and disease control rate was 76.5%. The patients who got a decrease of CEA, CYFRA21-1 and CA125 had a higher objective response rate than those who got an increase of them. The patients could be divided into three groups according to the CEA changes before and after two cycles of chemotherapy, these were the decreased group, stable group and increased group, the objective response rates were 48%,43.1%and 31.7%and the p value was 0.014. When compared between them we found that the group with decreased CEA had a higher ORR than that of the group with increased CEA and the p value was 0.004. Likewise, the ORRs in the groups with decreased, stable and increased cyfra21-l were 45.3%,41.9%and 24.6%and the p value between them was <0.001. When compared between them we found that the group with decreased CYFRA21-1 had a higher ORR than that of the group with increased CYFRA21-1 and the p value was 0.002. The ORRs in the groups with decreased, stable and increased CA125 were 47.3%,38.1%and 25.8%and the p value between them was 0.002. When compared between them we found that the group with decreased CA125 had a higher ORR than that of the group with increased CA125 and the p value was<0.001. We used ROC curve to analyze the changed percentage of tumor marker and the chemotherapeutic efficacy. When we use decreased 34.8 percent of CEA to predict partial remission, the sensitivity is 53.7%and the specificity is 52.2%(p=0.033). When we use decreased 56.1 percent of CYFRA21-1 to predict partial remission, the sensitivity is 59.1%and the specificity is 58.4%(p=0.002). And when we use decreased 48.9 percent of CA125 to predict partial remission, the sensitivity and specificity are 56.3%and 53.2%individually (P=0.001). While the increase of NSE and CA125 could predict progression, when we use increased 25 percent of NSE to predict progression, the sensitivity is 63.6%and the specificity is 53.2%(p=0.0l7). When we use increased 27.1 percent of CA125 to predict progression, the sensitivity and specificity are 68.3%and 59.4%individually (p=0.001). But we found no predictive value of the serum SCC. Because of the losing follow-up and the influencing of maintenance therapy, there were only 94 cases can be used to analyze progression-free survival. During all these 94 patients the mean PFS is 3.6±2.7 (1-12) months, the five tumor markers had no effects on PFS. Subgroup analysis showed that in female patients the PFS with normal NSE and high NSE at diagnosis were 3.0±0.4 months and 2.0±0.6 months and the p value was 0.008. The PFS of female patients with serum cyfra21-1 normal or high level after two cycles of chemotherapy were 3.0±0.4 months and 1.8±0.5 months and p value was 0.004. The PFS of non-smoker patients with serum cyfra21-1 normal or high level after two cycles of chemotherapy were 3.0±0.3 months and 2.0±0.4 months and p value was 0.003.Conclusion:?During the first-line chemotherapy of advanced NSCLC, the changes of CEA, CYFRA21-1, NSE and CA125 before and after two cycles of chemotherapy could be used to predict chemotherapeutic efficacy. The decreased extent of CEA, CYFRA21-1 and CA125 could be used to predict partial remission and the increased extent of NSE and CA125 could be used to predict progressed disease.?In predicting ORR, the predictive value of CEA decline extent is mainly appearent in patients with women, non-ager and adenocarcinoma. The predictive value of CYFRA21-1 decline extent is mainly appearent in male patients. The predictive value of CA125 decline extent is mainly appearent in male, non-ager and adenocarcinoma.?In predicting PD, the predictive value of CA125 increase extent is mainly appearent in male, non-ager and adenocarcinoma. There is no apparent group selection in the predictive value of NSE increase.?In PFS:The level of serum tumor maker before, after two cycles of chemotherapy and the changes between them had no significant effect on PFS. The female patients with normal serum NSE had longer PFS than those with high serum NSE. The PFS of patients whose serum CYFRA21-1 was higher than normal after two cycle chemotherapy was short. |
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