非小细胞肺癌的预后因素及多变量分析

Mulivariate analysis of prognostic factors in non small cell lung cancer

寻找非小细胞肺癌（ＮＳＣＬＣ）独立的预后因素，识别手术后复发和死亡的高危险性病人，以指导临床治疗。方法随访ＮＳＣＬＣ病人８５例。采用组织学观察、免疫组织化学及聚合酶链反应－单链构象多态性（ＰＣＲ－ＳＳＣＰ）方法和ＤＮＡ图象分析技术，采用Ｃｏｘ回归模型，多变量分析了临床、病理及主要生物学等１３项因素。结果本组病例中位随访时间为４７个月；３年、５年总体生存率分别为６６％和６１％。Ｃｏｘ回归显示，早期复发和死亡的单变量预后因素（Ｐ＜０．０５）为：淋巴结状况、ｐＴＮＭ分期、瘤栓形成、微血管数目、Ｋｉ－６７抗原标记率、ＤＮＡ相对含量以及ｐ５３基因突变；其中微血管数目和ｐＴＮＭ分期（均Ｐ＜０．０１）为ＮＳＣＬＣ独立的预后因素，并由此建立了ＮＳＣＬＣ的复发和死亡预测模型，得出了预后指数（ＰＩ）。结论ＰＩ可能是临床评价病人预后、识别ＮＳＣＬＣ手术后复发的高危险性病人很有实用价值的指标。

Objectives To find independent prognostic factor of non small cell lung cancer (NSCLC), identify the population with 'high risk' of recurrence and death in resected NSCLC, and direct adjuvant therapy for clinical doctors. Methods 85 resected patients from NSCLC were followed up. All patients were subjected to the study by light microscope, immunochemistry, PCR SSCP method, and DNA image analysis. Thirteen clinical, pathological, and biological factors were analysed by Cox regression model. Results The median follow up period was 47 months. The overall 3 year survival rate was 66% and the overall 5 year survival rate 61%. Cox regression showed significant univariate predictors ( P <0.05) of early recurrence and death for NSCLC were lymphnode status, pTNM, tumor emboli, microvessel count, Ki 67 antigen labeling, DNA relative content and p53 gene mutation. Microvessel count ( P <0.001) and pTNM ( P =0.006) were independent predictors of early recurrence and cancer death. According to the multivariate model for predicting early recurrence and cancer death, prognostic index (PI) was calculated. Conclusion The PI may be a useful clinical tool for evaluating prognosis of patients and identifying the population with 'high risk' of recurrence and death in NSCLC.