对于患有不可切除的有限阶段小细胞肺癌的老年患者的治疗策略
Rui Zhou1, Wen-Zhu Li1, Yue Cong2
1Department of Oncology, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111, Dade Road, Guangzhou, 510120, Guangdong, China.
概括
积极治疗改善了患有有限阶段小细胞肺癌 (LS-SCLC) 的老年患者的生存率. 单独的放射治疗可能是早期疾病的最佳治疗方法,提供与组合疗法相比的生存率,没有额外的毒性.
科学领域:
- 老年瘤学 老年瘤学
- 胸部瘤学 胸部瘤学
- 临床试验设计 临床试验设计
背景情况:
- 患有有限期小细胞肺癌 (LS-SCLC) 的老年患者在临床试验中代表性不足.
- 最佳的治疗策略缺乏证据,特别是对于脆弱的患者.
- 对密集的并发化疗或放射治疗的耐受性降低是一个关键问题.
研究的目的:
- 为了评估主动治疗与老年LS-SCLC患者的息治疗的有效性.
- 为了比较不同的活性治疗方式 (化疗,放射治疗,联合治疗).
- 根据疾病阶段和患者的健康状况,确定最佳的,个性化的治疗策略.
主要方法:
- 从SEER数据库中对3649名老年患者 (≥75岁) 进行了回顾性队列研究,这些患者患有不可切除的LS-SCLC.
- 分类为积极治疗 (化疗,放射治疗或两者) 或息治疗组的患者.
- 倾向性得分匹配 (PSM) 用于最小化偏差;癌症特定存活率 (CSS) 和整体存活率 (OS) 的比较.
主要成果:
- 与息治疗 (P<0.001) 相比,积极治疗显著改善了CSS (12 vs. 4 个月) 和OS (11 vs. 4 个月).
- 结合化学放射治疗 (C+R) 显示出最好的结果 (中位数CSS:15个月).
- 对于早期疾病 (T1或N0),单独的放射治疗 (R) 优于单独的化疗 (C) (调整HR为CSS=0.554,P=0.001);单独的R与较低的疾病负担 (T1N0-2,T2N0) 的C+R相当.
结论:
- 在老年LS-SCLC患者中应考虑积极治疗.
- 基于疾病阶段和患者健康状况的个性化治疗强度至关重要.
- 单独进行放射治疗是早期疾病 (T1N0-2,T2N0) 的可行,毒性较低的选择,提供与联合治疗相比的生存率.
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