| Objective Combined small cell lung carcinoma(CSCLC) is defined by the World Health Organization(WHO) as small cell carcinoma combined with an additional component consisting of any non–small cell histologic type, including adenocarcinoma, squamous cell carcinoma(SCC), large cell neuroendocrine carcinoma(LCNEC), spindle cell carcinoma and so on. CSCLC which shows a more aggressive clinical course and less sensitive to chemotherapy than SCLC has been reported to account for 25-30% of all SCLC. There have not been standard treatment protocols for CSCLC by then, and patients are managed as SCLC, but the prognosis of CSCLC is worse than that of pure SCLC. Nowadays we usually argue that the reason of resistence to chemotherapy is due to the non-SCLC(NSCLC) components in CSCLC. Since the most non-SCLC(NSCLC) components in CSCLC is adenocarcinoma, some domestic and foreign expert have attempted to explore the effects of the chemotherapeutic regimen based on 3 drugs(taxol+ carboplatin/cisplatin+ etoposide) on SCLC. However there have yet to reach a consensus that 3drugs regimen have advantage in effectiveness and safety over 2 drugs regimen. We conduct such a study to compare the efficacy and adverse effects of the chemotherapeutic regimen based on 3 drugs(taxol+ carboplatin/ cisplatin+etoposide)and 2 drugs(carboplatin/ cisplatin+ etoposide)on combined small-cell lung cancer(CSCLC).Method A retrospective study was based on the data of CSCLC patients who confirmed pathologically and treated between July 2000 and April 2013. Among these patients, 19 patients received 3 drugs regime and 43 patients received 2 drugs regime. Chi square tests were adopted to compare the general condition of the two groups. The Kaplan–Meier method was used to calculate the survival rate and depict the survival curves. The Cox regression model was used to analyze the independent factors affecting the overall survival(OS). All patients received at least two cycles of chemotherapy and experienced full follow-up. For each patient, the efficacy was evaluated using RECIST1.1 every 2 cycles and the toxicity was evaluated based on WHO criteria every cycle. Statistical analyses were performed using IBM SPSS Statistics version 13.0. Hazard ratios(HR) and 95 % confidence interval(CI) were generated. All P values were two sided, and P 〈 0.05 was considered statistically significant. Chi square tests or the Fisher’s exact tests were adopted to compare between groups. The median of the overall survival was determined by theKaplan–Meier method and compared among different groups using the log-rank test.Result The response rate between the 3 drugs group and 2 drugs group were statistically significant(90%vs53%,P﹦0.033). There was no statistical difference on disease control rate between in 3 drugs group and 2 drugs group(100%vs86%,P﹦0.212). The 3 drugs regimen could bring about a better median progression-free survival than the 2 drugs regimen, which failed to reach a statistical difference(10.5vs9.8,P﹦0.484). There was no statistical difference in median overall survival between in 3 drugs group and 2 drugs group(24.0vs17.5,P﹦0.457). The rates of grade Ⅳ bone marrow depression and terminating the original regime in 3 drugs group were both significantly higher than in 2 drugs group(26.3% vs7.0%, P﹦0.036;31.6% vs14.7%, P ﹦ 0.004). Univariate analysis showed PS( scores), Stage,Lymphnode metastasis, Distant metastasis, prophylactic cranial radiotherapy, and surgical resection were of statistical significance, further multivariate analysis by step-wise logistic regression indicated that PS(hazard ratio 2.132, P =0.015),Lymphnode metastasis(hazard ratio 1.482, P =0.007), as well as Distant metastasis(P=0.007) remained independent predictors of overall survival.Conclusions Compared with 3 drugs regime, 2 drugs regime has almost same survival rate and lower toxicity. We must pay close attention to the adverse reactions when using the TEP/TCE regimen, and so far two-agents based regimen should be one of standard treatment on CSCLC. |
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