ⅡB和Ⅲ期非小细胞肺癌预后相关因素的COX模型分析

Multivariate analysis by COX proportional hazards model on prognoses of patients with ⅡB,Ⅲ non-small cell lung cancer

目的 :研究影响ⅡB、ⅢA、ⅢB期非小细胞肺癌 (NSCLC)长期生存的预后因素。方法 :回顾性队列研究 113例ⅡB、ⅢA、ⅢB期NSCLC的病历资料 ,生存曲线用Kaplan Meier法绘制 ,预后价值判断用Logrank检验 ;所有变量均进入COXproportionalhazardregression模型。统计软件为SPSS 10 0 ,取α =0 0 5标准筛选变量。结果 :单因素分析显示 ,性别差异、年龄 >60岁、有无临床症状、有无吸烟史、腺癌或鳞癌等不同的组织类型、病灶直径 >3cm、受累的淋巴结直径 >2cm等对ⅡB、ⅢA、ⅢB期NSCLC患者 5年生存率无明显影响 ,P >0 0 5 ;KPS、有无体质量减轻、临床分期、病灶数目、受累淋巴结分期、组织分化、治疗手段等 7个因子对ⅡB、ⅢA、ⅢB期NSCLC患者生存时间有影响 ,经Logtest检验 ,P <0 0 5。COX模型分析 :唯独KPS、临床分期 2个因子P <0 0 1。结论 :生活质量 (KPS)、有无体质量减轻、临床分期、病灶数目、受累淋巴结分期、组织分化、治疗手段等 7个因子对ⅡB、ⅢA、ⅢB期NSCLC患者生存时间有影响 ,但唯独KPS、临床分期

OBJECTIVE:To evaIuate the influence of risk factors on the survival of patients with ⅡB,ⅢA and ⅢB non-small cell lung cancer(NSCLC).METHODS:A retrospective analysis was performed on 113 cases of NSCLC limited at ⅡB,ⅢA and ⅢB stages.Survival curves were plotted according to the Kaplan-Meier method.Associated with prognosis were evaluated by Logrank test.A multivariate anaysis of prognositic factors was performed by using COX proportional hazard regression model.RESULTS:The factors with inclusion of performas status (P.S),weight loss,differentiation,TNM staging system,lymph node status,solidary focul or multiple foculs,and treatment were confirmed to be significantly associated with the survival time in univariate analysis,P<0.05.However,the gender,age (> years old),symptoms,smoking,histology, tumor size (≥3 cm) and presence of bulky lymph node(diameter over 2 cm) showed little statistical significance on the effect of survival function,P>0.05.In the COX proposal hazard model, only the two factors (PS, and stage) could be independent indicators for the prognosis of patients with ⅡB,ⅢA and ⅢB stage NSCLC,P<0.01. CONCLUSIONS:PS and TNM staging system are the independent and important prognostic factors for the patients with ⅡB,ⅢA and ⅢB stage NSCLC.