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华西医学  2011 

帕米膦酸二钠和唑来膦酸治疗非小细胞肺癌骨转移疗效和安全性比较

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Keywords: 非小细胞肺癌,骨转移,骨相关事件,帕米膦酸二钠,唑来膦酸

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Abstract:

【】 目的 评价伴骨转移的非小细胞肺癌(non-smallcelllungcancer,NSCLC)患者在接受帕米膦酸二钠和唑来膦酸治疗后的有效性和安全性。 方法 2007年6月-2008年12月,74例伴骨转移的NSCLC,患者接受了双膦酸盐治疗,其中50例接受帕米膦酸二钠治疗,24例接受唑来膦酸治疗。帕米膦酸二钠90mg,静脉滴注3h,每4周重复1次;唑来膦酸4mg,静脉滴注15min,每4周重复1次。对可能影响其骨相关事件发生时间及生存率的各种临床?病理、治疗方法等因素进行分析,用Kaplan-Meier曲线及Logrank检验生存率差异,对不良反应的发生率等采用χ2检验。 结果 18个月无骨相关事件生存率和总体生存率在帕米膦酸二钠及唑来膦酸组分别为19.3%、28.9%(P=0.253)和33.4%、38.2%(P=0.745),两组比较,差异均无统计学意义。两组患者不良反应中帕米膦酸二钠组8例(16.0%),唑来膦酸组6例(25.0%),两组比较差异无统计学意义(χ2=0.200,P=0.655)。7例患者用帕米膦酸二钠治疗失败后再用唑来膦酸治疗,其中位无骨相关事件生存时间为2个月(95%CI0~4.6)。 结论 唑来膦酸和帕米膦酸二钠在缓解延迟骨相关事件发生时间疗效和不良反应发生率相当。用帕米膦酸二钠治疗失败后再用唑来膦酸可延缓骨相关事件发生时间。?【Abstract】 Objective Toretrospectivelyevaluatetheefficacyandsafetyofpamidronatedisocliumandzoledronicacidintreatingnon-small-celllungcancer(NSCLC)patientswithbonemetastasis. Methods Thisstudyincluded74patientswhoweretreatedwithbisphosphonatebetweenJune2007andDecember2008.Fiftyweretreatedwithpamidronatedisodium,and24withzoledronicacid.Pamidronatedisodiumwasadministeredintravenouslyoncefor3hoursevery4weeksatadoseof90mg.Zoledronicacidwasgivenintravenouslyoncefor15minutesevery4weeksatadoseof4mg.Variousclinical,pathologicalfactorsandtreatmentmethodsrelatedtotheoccurringtimeofskeletalrelatedevents(SRE)andsurvivalratewereanalyzed.Kaplan-MeiercurveandLogrankwereadoptedtodetectthedifferenceinsurvivalratebetweenpatientstreatedwithdifferentmedicine,andweusedχ2testtodiscovertherateofadverseeventsofthepatients. Results Eighteen-monthSRE-freesurvivalandoverallsurvivalrateinthepamidronatedisodiumandzoledronicacidgroupwere19.3%vs.28.9%(P=0.253),and33.4%vs.38.2%(P=0.745)respectively.Therewere8(8/50)casesofadverseeventsinthepamidronatedisodiumgroup,and6(6/24)inthezoledronicacidgroup(χ2=0.200,P=0.655).TheSRE-freesurvivaltimeforsevenpatientswhoweretreatedwithzoledronicacidafterpamidronatedisodiumfailedwas2months(95%CI0-4.6). Conclusions Comparedwithzoledronicacid,pamidronatehasequalefficacyindelayingSREandincidenceofadverseeffects.AdministeringzoledronicacidafterpamidronatefailedcanalsodelaytheoccurringtimeofSRE.

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