小细胞肺癌患者预后因素分析

Prognostic factors in patients with small cell lung cancer

目的 研究小细胞肺癌 (SCLC)患者的预后相关因素 ,建立有临床实用性的预后模型。方法 根据 6 0例SCLC患者的临床及随访资料 ,采用Kaplan Meier和Cox模型回归方法 ,分析SCLC患者的预后影响因素 ,并建立预后指数 (PI)模型。这些因素包括临床常规因素和血清神经元特异性烯醇化酶 (NSE)、癌胚抗原 (CEA)、细胞角蛋白 19片段 (CYFRA2 1 1)、糖链抗原 12 5 (CA12 5 )、白细胞介素 2(IL 2 )、可溶性白细胞介素 2受体 (sIL 2R)等 6种肿瘤标记物。结果 单因素分析显示 ,KPS评分 <80分和广泛期SCLC患者预后较差 ,患者的年龄、性别、吸烟指数与预后无关。血清NSE、CEA、CA12 5和sIL 2R水平与预后有关 ,CYFRA2 1 1和IL 2虽然在SCLC患者也有升高 ,但与预后无关。多因素分析表明 ,NSE、临床分期和治疗情况是预后的独立影响因素。CEA、NSE和临床分期是影响预后的治疗前独立因素。据此建立PI模型 :PI =CEA +NSE +stage ,其中CEA >5 .0 μg/L和NSE >30 μg/L附值 1,否则附值为 0 ;临床分期为局限期stage附值 0 ,广泛期附值为 1。结论 SCLC患者的临床分期、是否系统治疗以及治疗前血清NSE水平是预后的独立影响因素。排除治疗因素的影响 ,则血清CEA、NSE和临床分期是治疗前的独立预后因素。根据血清CEA、NSE和临床分期?

Objective To investigate the prognostic factors of small cell lung cancer (SCLC) and establish a reliable model of clinical prognostic index. Methods Kaplan-Meier and Cox regression were used to analyze the relationship betw een survival time and prognostic factors in 60 cases of SCLC. The prognostic fac tors included clinical and laboratory parameters,serum cytokeratin fragment 19 (CYFRA21-1),carcinoembryonic antigen (CEA),neuron-specific enolase (NSE),CA 125,interleukin-2 (IL-2) and soluble interleukin-2 receptors (sIL-2R). Results Kaplan-Meier analysis showed that poor prognosis was in patients with KPS<80 or extensive disease and unrelated to other clinical parameters such as age,sex an d smoking index,and in patients with serum NSE>30 μg/L,CEA>5.0 μg/L, CA125>37 KU/L and sIL-2R>500 KU/L. Serum IL-2 and CYFRA21-1 were also elev ated,but had no significant prognostic value. Multivariate analysis indicated t hat serum NSE,stage and treatment of disease were independent prognostic factor s. The three prognostic factors enabled establishment of a prognostic index (PI) based on a simple algorithm: PI = NSE (0 if≤30 μg/L,1 if >30 μg/L) + stage(0=LD,1=ED) + CEA(0 if ≤ 5.0 μg/L,1 if >5.0 μg/L). Conclusion The stage of disease,systemic treatment and the level of serum NSE are indepe ndent prognostic factors. Without considering the influence of treatment-relate d factors on survival,the levels of serum CEA,NSE and stage of disease before t reatment are significant independent prognostic factors. PI calculated on the ba sis of CEA,NSE and stage is recommended to predict the survival of SCLC.