【摘要】 目的 評價伴骨轉移的非小細胞肺癌（non-small cell lung cancer，NSCLC）患者在接受帕米膦酸二鈉和唑來膦酸治療后的有效性和安全性。 方法 2007年6月-2008年12月，74例伴骨轉移的NSCLC，患者接受了雙膦酸鹽治療，其中50例接受帕米膦酸二鈉治療，24例接受唑來膦酸治療。帕米膦酸二鈉90 mg，靜脈滴注3 h，每4周重復1次；唑來膦酸4 mg，靜脈滴注15 min，每4周重復1次。對可能影響其骨相關事件發生時間及生存率的各種臨床﹑病理、治療方法等因素進行分析，用Kaplan-Meier曲線及Log rank檢驗生存率差異，對不良反應的發生率等采用χ2檢驗。 結果 18個月無骨相關事件生存率和總體生存率在帕米膦酸二鈉及唑來膦酸組分別為19.3%、28.9%（P=0.253）和33.4%、38.2%（P=0.745），兩組比較，差異均無統計學意義。兩組患者不良反應中帕米膦酸二鈉組8例（16.0%），唑來膦酸組6例（25.0%），兩組比較差異無統計學意義（χ2=0.200，P=0.655）。7例患者用帕米膦酸二鈉治療失敗后再用唑來膦酸治療，其中位無骨相關事件生存時間為2個月（95%CI：0~4.6）。 結論 唑來膦酸和帕米膦酸二鈉在緩解延遲骨相關事件發生時間療效和不良反應發生率相當。用帕米膦酸二鈉治療失敗后再用唑來膦酸可延緩骨相關事件發生時間。【Abstract】 Objective To retrospectively evaluate the efficacy and safety of pamidronate disoclium and zoledronic acid in treating non-small-cell lung cancer (NSCLC) patients with bone metastasis. Methods This study included 74 patients who were treated with bisphosphonate between June 2007 and December 2008. Fifty were treated with pamidronate disodium, and 24 with zoledronic acid. Pamidronate disodium was administered intravenously once for 3 hours every 4 weeks at a dose of 90 mg. Zoledronic acid was given intravenously once for 15 minutes every 4 weeks at a dose of 4 mg. Various clinical, pathological factors and treatment methods related to the occurring time of skeletal related events (SRE) and survival rate were analyzed. Kaplan-Meier curve and Log rank were adopted to detect the difference in survival rate between patients treated with different medicine, and we used χ2 test to discover the rate of adverse events of the patients. Results Eighteen-month SRE-free survival and overall survival rate in the pamidronate disodium and zoledronic acid group were 19.3% vs. 28.9% (P=0.253), and 33.4% vs. 38.2% (P=0.745) respectively. There were 8 (8/50) cases of adverse events in the pamidronate disodium group, and 6 (6/24) in the zoledronic acid group (χ2=0.200, P=0.655). The SRE-free survival time for seven patients who were treated with zoledronic acid after pamidronate disodium failed was 2 months (95%CI: 0-4.6). Conclusions Compared with zoledronic acid, pamidronate has equal efficacy in delaying SRE and incidence of adverse effects. Administering zoledronic acid after pamidronate failed can also delay the occurring time of SRE.
Objective To investigate the clinical features of non-small cell lung cancer (NSCLC) patients with long-term survival and the related factors for treatment. Methods A retrospective analysis of clinical features, treatment factors, and survival was performed for 963 patients with pathologically confirmed stage Ⅳ NSCLC between January 2010 and December 2015 from Department of Thoracic Oncology, West China Hospital, Sichuan University. Results The median overall survival (OS) of the 963 patients was 20.8 months, and the 1-, 3-, 5-, and 7-year survival rates were 72.0%, 21.4%, 15.2%, and 4.8%, respectively. There were 81 patients in the long-term survival group (OS>60 months) and 882 in the non-long-term survival group (OS<60 months). Previous surgery, thoracic radiotherapy and epidermal growth factor receptor (EGFR) gene positive significantly increased the 5-year actual survival rate, reducing the risk of death by 62.0%, 58.8%, and 58.1%, respectively. Compared with the non-long-term survival group, more patients in the long-term survival group received two or more means of treatment including surgery, thoracic radiotherapy, and targeted therapy (28.4% vs. 11.6%, P<0.001) and more patients benefited from fourth- or further-line treatment (24.7%vs. 11.1%, P<0.001). Cox multivariate regression analysis indicated that performance status [hazard ratio (HR)=1.388, 95% confidence interval (CI) (1.199, 1.608), P<0.001] , N stage [HR=1.160, 95%CI (1.058, 1.272), P=0.002] , EGFR gene status [HR=0.588, 95%CI (0.469, 0.738), P<0.001] , previous surgery [HR=0.626, 95%CI (0.471, 0.832), P=0.001] , and thoracic radiotherapy [HR=0.592, 95%CI (0.480, 0.730), P<0.001] were independent prognostic factors of OS. Conclusions Good performance status, early N staging, EGFR mutation, previous surgery, and thoracic radiotherapy are important prognostic factors affecting the survival of advanced NSCLC patients. Long-term survival benefits from combined treatment and effective further-line therapies.