LONG-TERM SURVIVORS IN METASTATIC NON SMALL-CELL LUNG-CANCER - AN EASTERN COOPERATIVE ONCOLOGY GROUP-STUDY
LONG-TERM SURVIVORS IN METASTATIC NON SMALL-CELL LUNG-CANCER - AN EASTERN COOPERATIVE ONCOLOGY GROUP-STUDY
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DOI：
10.1200/jco.1986.4.5.702
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发表时间：
1986-05-01
影响因子：
45.3
通讯作者：
RUCKDESCHEL, JC
中科院分区：
文献类型：
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作者：
FINKELSTEIN, DM;ETTINGER, DS;RUCKDESCHEL, JC
1979年12月至1983年6月，美国东部肿瘤协作组（ECOG）对893例体能状态良好的转移性非小细胞肺癌（NSCLC）患者进行了7种III期联合化疗。总体中位生存期为23.5周，治疗之间无显著差异。168例患者（19%）存活> 1年，36例（4%）存活> 2年。依托泊苷-铂联合治疗的1年生存率最高（25%）。丝裂霉素-长春碱-铂（MVP）治疗的缓解率最高，1年生存率（12%）明显低于其他治疗方案（P = 0.003）。对治疗前特征进行分析，将存活> 1年的患者与未存活的患者区分开来，初始体能状态为0、无骨转移、女性、无皮下转移、非大细胞组织学、既往体重减轻< 5%、无肩部或手臂疼痛症状以及无肝转移是较长生存期的预测因素。特别值得关注的是，对于达到最佳缓解时间较长的患者，缓解持续时间显著较长（P = .002）。此外，存活> 1年的患者比未存活1年的患者经历了更大程度的非致死性毒性，特别是胃肠道和血液学毒性（P = .006）。对32例2年生存者和32例匹配对照者的详细图表回顾表明，治疗开始后3个月时体力状态的改善或改善以及血清白蛋白水平的下降都是生存期延长的重要预测因素。
Between December 1979 and June 1983 the Eastern Cooperative Oncology Group (ECOG) treated 893 good-performance status patients with metastatic non-small-cell lung cancer (NSCLC) on one of seven phase III combination chemotherapies. The overall median survival was 23.5 weeks with no significant differences between treatments. One hundred sixty-eight patients (19%) survived > 1 year and 36 (4%) for > 2 years. The etoposide-platinum combination had the highest proportion of 1-year survivors (25%). Mitomycin-vinblastine-platinum (MVP), which had demonstrated the highest response rate, had significantly fewer 1-year survivors (12%) than any other regimen (P = .003). Analysis of pretreatment characteristics that distinguished patients who survived > 1 year from those who did not demonstrated that an initial performance status of 0, no bone metastases, female sex, no subcutaneous metastases, non-large-cell histology, < 5% prior weight loss, no symptoms at shoulder or arm pain, and no liver metastases were predictors of longer survival. Of particular interest was the finding that response duration was significantly longer (P = .002) for those patients who experienced a longer time to best response. In addition, patients who survived > 1 year experienced greater degrees of nonlethal toxicity, in particular, gastrointestinal and hematologic, than patients who did not survive 1 year, (P = .006). A detailed chart review of 32 2-year survivors and 32 matched controls demonstrated that maintainance or improvement of performance status and maintainance of serum albumin levels at 3 months from the initiation of treatment were both important predictors of longer survival.