438例肺癌恶性胸腔积液的诊治及预后因素分析

Analysis of diagnosis and treatment and prognosis factor for 438 cases of malignant pleural effusion with lung cancer

目的分析肺癌恶性胸腔积液的诊治特点及疗效评估,探讨其预后因素及有效的诊治方案。方法回顾性分析2009年10月至2013年12月该院收治的临床诊断肺癌恶性胸腔积液患者728例的临床资料,随访至2014年9月30日。对可供分析的有效随访肺癌恶性胸腔积液患者438例的诊治情况进行分析。主要观察指标为发生率、有效率、无进展生存期和总生存期。结果肺癌恶性胸腔积液总体中位无进展生存期为4个月,中位生存期8个月。多变量Logistic回归分析表明,男性、小细胞肺癌、胸腔积液大量、右侧胸腔积液可能是恶性胸腔积液局部难控制的独立因素。胸腔积液4周可控制患者总生存优于难控制者(中位生存时间:9个月vs.5个月,P<0.001)。胸腔积液2周控制率与4周控制率总生存预后无明显差异。多变量Cox回归分析表明,组织学类型、局部缓解时间、化学治疗周期数和酪氨酸激酶抑制剂(TKI)治疗是进展风险的独立预测因素。鳞癌和其他组织学类型患者的进展风险低于腺癌(P=0.007)。胸腔积液4周内缓解患者的进展风险显著低于未缓解者(P=0.004)。完成化学治疗周期数大于2周期以及服用TKI治疗的患者进展风险都显著降低(P<0.001;P=0.026)。对总生存期而言,女性、鳞癌、不伴心包积液、3周期及以上化学治疗、TKI治疗、胸腔积液4周内可控制的患者总生存预后较好。结论男性、胸腔积液大量、右侧胸腔积液是恶性胸腔积液局部难控制的独立预后因素。胸腔积液局部可控制患者总生存优于难控制者。组织学类型、胸腔积液可控缓解时间、化学治疗周期数和TKI治疗是肺癌恶性胸腔积液的进展风险和总生存的独立预测因素。

Objective To analyze the characteristics of diagnosis and therapeutic effect of malignant pleural effusion with lung cancer,and explore the prognostic factors and effective diagnosis and treatment plans.Methods A retrospective analysis includes 728 cases of definite pleural effusion with lung cancer from October 2009 to December 2013 in our hospital,which was followed-up to September 30,2014,and 438 cases were available analyzed.The main outcome measures were incidence,efficiency,progression-free survival and overall survival.Results The overall median progression-free survival and the median survival of malignant pleural effusions with lung cancer was respectively 4months and 8months.males,small cell lung cancer,massive pleural effusion,and right pleural effusion may be the independent factors of local unmanageable malignant pleural effusion by multivariable Logistic regression.The overall survival of pleural effusion with locally control（less than four weeks）was better than those with unmanageable（mOS：9month vs.5month,P〈0.001）.It was no significant difference of the control rate for overall survival prognosis between pleural effusion with two weeks and those with four weeks.histological type,partial remission time,the number of cycles of chemotherapy and TKI therapy may be the independent development risk by progression with Multivariate Cox regression analysis.the progress risk of patients with squamous cell carcinoma and other histological types were lower than that of adeno carcinoma（P=0.007）.The progress risk of development of patients with 4weeks of pleural effusion was significantly lower than that of the non remission（P=0.004）,the progress risk of complete chemotherapy cycle number 2cycles and takingTKI treatment were significantly reduced（P〈0.001;P=0.026）.Gender,histological type,pericardial effusion,partial remission time,cycles of chemotherapy and TKI were the independent prognostic factors for overall survival.The overall survival prognosis of patients with Female,squamous cell carcinoma,no pericardial effusion,and over three cycles of chemotherapy,TKI therapy,and local controlled in 4weeks was better.Conclusion Male,massive pleural effusion and right pleural effusion are independent predictive factors of local unmanageable malignant pleural effusion.The overall survival of pleural effusion with locally control was better than the patients with refractory control.Histological type,controllable relief time of pleural effusion,cycles of chemotherapy and TKI therapy were the independent predictive factors of progression and overall survival.