234例小细胞肺癌复发转移的危险因素分析

Predictive risk factors for recurrence and metastasis in 234 patients with small-cell lung cancer

目的寻找影响小细胞肺癌(small-cell lung cancer,SCLC)控制及复发转移的标志物,以期为临床提供指导。方法研究纳入2013—2018年间234例SCLC患者,通过电子病例系统收集患者临床特征以及预后相关实验室检查指标。Kaplan-Meier法生存分析,Cox模型多因素生存分析,R软件绘制列线图可视化预测SCLC患者的无进展生存(PFS)。结果单因素分析发现吸烟史、分期、肝转移、脑转移、骨转移、一线化疗≥4周期、胸部放疗、中性粒细胞淋巴细胞计数比值、乳酸脱氢酶(LDH)、神经元特异性烯醇化酶、癌胚抗原等11个因素与患者的PFS密切相关;多因素分析发现吸烟史、胸部放疗、一线化疗≥4周期、治疗前LDH水平是SCLC复发转移的独立危险因素。治疗前血清LDH≥215.7(U/L)组中位PFS期优于LDH<215.7(U/L)组(10.8个月:9.0个月,P=0.001),肝转移患者中LDH水平表达增高。自抽样内部验证一致性指数为0.638(95%CI为0.594~0.682),模型分辨率良好。结论胸部放疗、吸烟史、一线化疗周期数、治疗前LDH水平是SCLC患者PFS的独立预后因素。临床工作中可根据患者治疗前LDH水平对患者进行分层管理。

Objective This study aimed to find indicators of recurrence and metastasis with small-lung cancer(SCLC).Methods Form 2013 to 2018,the study enrolled 234 SCLC patients.Clinical features and prognostic indicators related to prognosis were collected through the electronic case system.Kaplan-Meier method was used for survival analysis.Multivariate analysis performed by the Cox model.R software was used to draw a nomogram to predict progression-free survival(PFS)of SCLC visually.Results Smoking history,staging,liver metastasis,brain metastasis,bone metastasis,first-line chemotherapy≥4 cycles,thoracic radiotherapy,NLR,LDH,NSE,CEA were closely associated with PFS.Multivariate analysis revealed that smoking history,thoracic radiotherapy,first-line chemotherapy≥4 cycles,and LDH were independently related with PFS.PFS was significantly higher in patients with low LDH(10.8 months)than high levels(9.0 months).The expression of LDH increased in patients with liver metastases.The C-index of the nomogram was 0.638(95%CI:0.594-0.682).Conclusions Thoracic radiotherapy,smoking history,number of first-line chemotherapy cycles,and pretreatment serum LDH were independently associated with PFS in patients with SCLC.