局限期和广泛期小细胞肺癌合并胸腔积液临床特点及预后因素对比

The comparative analysis of clinical characteristics and prognostic factors of limited and extensive small cell lung cancer with pleural effusion

目的对比分析局限期和广泛期小细胞肺癌合并胸腔积液临床特点及预后因素,为其诊疗提供更多理论依据。方法回顾2012年1月至2015年1月于宝鸡市人民医院诊治的120例局限期小细胞肺癌合并胸腔积液(LSSCLC-PE组)和108例广泛期小细胞肺癌合并胸腔积液(ES-SCLC-PE组)的临床特点、生存时间(随访3年的总生存期和无进展生存期)及预后因素,并进行对比分析。结果LS-SCLC-PE组和ES-SCLC-PE组患者性别、年龄、是否吸烟、每日吸烟量、治疗方案及PCI上差异无统计学意义(P>0.05),具有可比性。但两组患者在胸腔积液量、积液是否含肿瘤细胞、TNM分期及KPS评分上差异有统计学意义(P<0.05),LS-SCLC-PE组和ES-SCLC-PE组患者中位总生存期(OS)分别为29.45月和24.00月,3年OS死亡率分别为41.67%和60.19%,差异有统计学意义(P<0.05);LSSCLC-PE组和ES-SCLC-PE组患者中位无进展生存期(PFS)分别为25.78月和20.38月,3年PFS死亡率分别为45.83%和69.44%,差异有统计学意义(P<0.05)。经Cox单因素及多因素分析后得知,积液含肿瘤细胞和TNM分期(T4N2/T1-4N3)是影响LS-SCLC-PE组患者预后的独立危险因素,差异有统计学意义(P<0.05),而胸腔积液量(大量)和TNM分期(T4N2/T1-4N3)则是影响ES-SCLC-PE组患者预后的独立危险因素,差异有统计学意义(P<0.05)。结论与局限期小细胞肺癌合并胸腔积液相比,广泛期小细胞肺癌合并胸腔积液生存期及生存率明显缩短;TNM分期是两者共同的独立危险因素,而积液含肿瘤细胞和大量胸腔积液分别是前后两者的独立危险因素。

Objective To compare and analyze the clinical characteristics and prognostic factors of limited and extensive small cell lung cancer with pleural effusion in patients,so as to provide more theoretical basis for its diagnosis and treatment.Methods The clinical characteristics,survival time(3-year follow-up total survival and progression-free survival)and prognostic factors of 120 patients with limited small cell lung cancer complicated with pleural effusion and 108 patients with extensive small cell lung cancer complicated with pleural effusion were retrospectively analyzed.Results LSSCLC-PE group and ES-SCLC-PE group had significant differences in pleural effusion volume,whether the effusion contained tumor cells,TNM stage and KPS score(P<0.05),but there were no significant differences in gender,age,whether smoking,daily smoking,treatment and PCI(P>0.05).The median OS in LS-SCLC-PE group and ES-SCLC-PE group were 29.45 months and 24.00 months,respectively,and the three-year OS mortality rates were 41.67%and 60.19%,respectively,and the differences were statistically significant(P<0.05).The median PFS in LS-SCLC-PE group and ESSCLC-PE group were 25.78 months and 20.38 months,respectively,and the three-year PFS mortality rates were 45.83%and 69.44%,respectively,and the differences were statistically significant(P<0.05).The results of Cox single factor and multivariate analysis showed that the effusion contains tumor cells and TNM staging(T4N2/T1-4N3)were independent risk factors for the prognosis of LS-SCLC-PE group,and the differences were statistically significant(P<0.05),while pleural effusion volume(large volume)and TNM staging(T4N2/T1-4 N3)were independent risk factors for the prognosis of ES-SCLCPE group,and the differences were statistically significant(P<0.05).Conclusion Compared with LS-SCLC-PE,the survival time and survival rate of ES-SCLC-PE were significantly shortened.TNM stage was the common independent risk factor for both,and the effusion contains tumor cells and massive pleural effusion were the independent risk factors of the former and the latter.