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高危软组织肉瘤优先获益于新辅助化疗加局部热疗

2011-06-30 MedSci原创 MedSci原创

 ASCO 2011报道:Issel等的一项研究报告提示,FNCLCC分级为2级的高危软组织肉瘤(STS)患者优先获益于新辅助化疗(NAC)联合局部热疗(RHT)。   研究者分析了一项随机Ⅲ期临床研究的数据,探索分级对NAC的预测价值。这项已完成的Ⅲ期研究显示,NAC上加用RHT对与肿瘤缓解、局部无进展生存(LPFS)及无病生存(PFS)均有益,完成RHT诱导治疗的患者总体生存(OS

 ASCO 2011报道:Issel等的一项研究报告提示,FNCLCC分级为2级的高危软组织肉瘤(STS)患者优先获益于新辅助化疗(NAC)联合局部热疗(RHT)。

  研究者分析了一项随机Ⅲ期临床研究的数据,探索分级对NAC的预测价值。这项已完成的Ⅲ期研究显示,NAC上加用RHT对与肿瘤缓解、局部无进展生存(LPFS)及无病生存(PFS)均有益,完成RHT诱导治疗的患者总体生存(OS)时间延长(Lancet Oncol 2010)。

  1997年7月~2006年11月,339例患者(符合此分析标准者,161例为2级,178例为3级)被随机分配接受NAC+RHT治疗[168 例,84例(50%)为2级,84例(50%)为3级]或单用NAC[171例,77例(45%)为2级,94例(55%)为3级]。分级根据 FNCLCC分级系统评估。对于分级的影响,使用卡普兰-梅耶(Kaplan-Meier)法估计生存率(LPFS、PFS和OS),并用对数秩(Log-rank)检验进行比较。使用包括分层变量(原发、复发、既往手术、解剖部位)的Cox回归模型进行多变量分析。

  结果显示,在整个研究中,分级是一个OS预测因素[2级相比于3级,危险比(HR)=1.40,可信区间(CI)为 1.01~1.92,P=0.041]。在NAC+GHT组(168例患者),2级患者的OS(2年87%,4年69%)显著好于3级患者(2年 69%,4年49%)(HR=1.79,CI为1.10~2.91,P=0.019)。在单用NAC组(171例患者)中,2级患者OS(2年79%,4 年58%)与3级患者OS(2年66%,4年54%)相比,无相关性可评估(HR=1.22,CI为0.76~1.94,P=0.411)。在NAC中加用RHT(NAC+GHT:84例,NAC:77例)增加2级患者LPFS(HR=0.54,CI为0.31~0.94,P=0.026)和 DFS(HR=0.63,CI为0.41~0.97,P=0.034),对3级患者的有效程度则低很多(NAC+GHT:84例,NAC:94例)(LPEF:HR=0.67,CI为0.41~1.09,P=0.104;DFS:HR=0.74,CI为0.51~1.07,P=0.110)。

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    2011-07-02 chg122
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    2011-07-02 qilu_qi

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