Analysis And Prediction Of Efficacy Of First-line Chemotherapy Of Advanced Non-small Cell Lung Cancer

Objective: Compare the effect of the four groups of chemotherapy withplatinum in patients with advanced non small cell lung cancer (NSCLC),analyze whether the difference effect is related to the clinical characteristics ofpatients. Analyze the relation between the the effect of chemotherapy and theserum tumor markers (TM) changes of patients with advanced NSCLC andevaluate the effect of TM in prediction of efficacy of first-line chemotherapyin patients with advanced NSCLC.Method:1232cases of NSCLC patients in the fourth hospital of Hebei MedicalUniversity from2008June to2012June the regimen as third generationchemotherapy drugs (paclitaxel, gemcitabine, docetaxel and vinorelbine)combined with platinum was collected through access to medical records andfollow-up measures. The datas include Gender, age, smoking status,pathological type, TNM stage, treatment, evaluation of efficacy,progression-free survival. Chi-square test was used to compare the differentefficacy of subgroups of patients. Kaplan-Meier method was used to compareprogression-free survival of patients. All the calculations were performed inSPSS13.0.2We analysed214patients with advanced non small cell lung cancerwho were enrolled in the fourth hospital of Hebei Medical University from2008June to2012June. All patients were treated with the third generation ofchemotherapeutic drugs (paclitaxel, gemcitabine, docetaxel and vinorelbine)combined with platinum in treatment, and all of them have therapeuticevaluation after first-line chemotherapy. Four tumor markers(CEA, NSE,CY21-1, SCC) which were associated with lung cancer were detected beforeand after2cycles of first-line chemotherapy. We analyzed the relationships between clinical curative effect and the changes of tumor markers. Chi-squaretest was used to compare the different efficacy of subgroups of patients.Kaplan-Meier method was used to compare progression-free survival ofpatients. All the calculations were performed in SPSS13.0.Results:1The total ORR（objective response rate）of232cases of advancedNSCLC patients receiving first-line chemotherapy was34.5%and theDCR(disease control rate) was72%. A comparison of four schemes of ORR,TP, DP, GP scheme was better than the NP scheme, P<0.05, the differencehad statistical significance. In terms of DCR, DP and GP scheme was betterthan the NP scheme, the difference had statistical significance.2Subgroup analysis showed that GP scheme in terms of ORR was betterthan that of NP in patients of squamous carcinoma group, the difference wasstatistically significant. In adenocarcinoma patients DP scheme was betterthan that of NP in both ORR and DCR, the difference had statisticalsignificance. Male patients with TP, DP, GP scheme were better than that ofNP in terms of ORR, in terms of DCR, DP, GP were better than that of NP,difference have statistical significance. In patients with malignant pleuraleffusion group GP scheme was better than that of NP in terms of ORR. Inpatients with smoking, TP, DP, GP is better than NP in terms of ORR. DP, GPwere also better than NP in terms of DCR, the difference was statisticallysignificant. In stage ⅢB patients, GP scheme was better than that of NP interms of DCR, the difference had statistical significance. In patients of nonelderly group, TP,DP,and GP scheme were better than that of NP scheme interms of ORR, GP scheme was better than that of TP and NP in terms of DCR,difference has statistical significance.3In terms of PFS, TP scheme with PFS for4.5months on average. DPscheme with PFS for5.2months on average. GP scheme with PFS for4.5months on average. NP scheme with PFS for4.5months on average. DPscheme was better than that of NP, P=0.038, the difference was statisticallysignificant. Subgroup analysis showed that DP scheme was better than that of NP in stage Ⅳ patients. In adenocarcinoma patients DP scheme was betterthan the other three.4The level of CEA in Serum before treatment had no significant effect tofirst-line chemotherapy curative effect. After2cycles of first-line treatment,the patients who got a normal CEA were better than those who got a increasedCEA in terms of ORR. The grope with decreased CEA had a higher ORR thanthat of the group with increased CEA. The grope with decreased or stableCEA had a higher DCR than that of the group with increased CEA.5The level of NSE in Serum before or after treatment had no significanteffect to first-line chemotherapy curative effect. The grope with decreased orstable NSE had a higher ORR than that of the group with increased NSE.6The level of CY21-1in Serum before or after treatment had nosignificant effect to first-line chemotherapy curative effect. The grope withdecreased CY21-1had a higher ORR than that of the group with increasedCY21-1.7The level of SCC in Serum before treatment had no significant effect tofirst-line chemotherapy curative effect. After2cycles of first-line treatment,the patients who got a normal SCC were better than those who got a increasedSCC in terms of DCR. The grope with decreased SCC had a higher ORR thanthat of the group with increased SCC.8Before treatment,the level of four tumor markers associated with lungcancer had no significant effect on PFS. The patients with normal serum SCCafter treatment had longer PFS than those with higher serum SCC, P=0.003.After chemotherapy, the patients whose serum CEA was stable had longerPFS than those serum CEA was higher than before.Conclusion:1During the first-line chemotherapy of advanced NSLCL, NP schemewas is weaker than the other four kinds of schemes in terms of ORR, And ismainly manifested in the elderly patients. DP scheme has longer PFS thanother three schemes, obviously in adenocarcinoma group.2GP scheme is better than NP scheme in patients with malignant pleural effusion. Topical application of cisplatin controlling pleural effusion is better.3The advanced NSCLC patients had better effect in first-linechemotherapy if the serum level of CEA, SCC, NSE or CY21-1was lowerthan before. After chemotherapy, the patients whose serum CEA was stablehad longer PFS than those serum CEA was higher than before. The patientswith normal serum SCC after treatment had longer PFS than those with higherserum SCC.