病人态度和肺癌生存期晚期非小细胞肺癌的前瞻性观察性研究.ppt

研究结果讨论 没有发现任何基线特征能强有力地预测医生正确判别病人“需求”类别的能力。这并不意味着基线特征与治疗需求不相关 研究结果讨论 患者需求类别和未校对的中位生存期 Chu DT, et al. Lung Cancer. 2009 Mar 3 比例(%) 中位生存期* 类别A 60.0 13.00 类别B 26.1 15.70 类别C 13.8 15.33 *P=0.0415 Chu DT, et al. Lung Cancer. 2009 Mar 3 Table 5 患者的需求类别和校对后的中位生存期 在对已知的预后因素校对后，患者对待治疗的态度（需求类别）不是一个独立的预测生存的预后因素 (P = 0.0503). 研究结果讨论 病人对延长生存期的愿望胜于对症状缓解的愿望。反之, 医生更可能比病人自身将其归为主要倾向为缓解症状。 所有入选本试验的病人之前都未接受过化疗,因此他们有可能低估了化疗相关的毒性反应的程度。 当医生考虑对一个病人最适合的治疗时，应减少对毒性的关注,而更多地关注治疗的可能的疗效 。 在这项研究中，患者对化疗的态度，不是一个独立的预测生存的预后因素 结论 谢 谢! * * * * Investigators may question the restriction to Gemzar-platinum in this study. Main arguments may be why we don’t allow to use older combinations (eg, etoposide-cisplatin, as in certain countries only few patients can afford a drug like Gemzar) and why not platinum combinations with another newer drug, eg, paclitaxel or vinorelbine. These are suggested responses: Older combinations no longer can be considered optimal treatment and thus SOC for these patients. Thus any such study today needs to be limited to patients who receive platinum with one of the newer agents. The companion slide set and the points reviewed here in slides 6 through 8 make it clear that Gemzar-platinum is one of today’s SOCs for such patients. As all new drug combinations have shown similar survival outcomes, the findings from this study will be applicable to any other combination of a platinum and one of the newer agents. As such it would not add value to include patients who receive other combinations. Although in certain countries only a small proportion of patients can receive Gemzar, fact is that many do so in routine care. It is these patients that we encourage the investigators to enroll in PLUS 1. Because this study will be conducted in many countries and with many investigators, the total number of patients will still be very high (in Asia alone the estimated number is 1300), i.e., high enough to allow answering the scientific questions of the study. A final reason to limit pa