小细胞肺癌术后化疗的预后分析

Prognostic of small cell lung cancer treated with postoperative chemotherapy： analysis of 111 cases

目的探讨小细胞肺癌术后化疗的生存期和影响预后的因素。方法对111例接受术后化疗的小细胞肺癌进行回顾性研究，并对临床、病理特点及治疗进行生存预后分析。结果总体病例中位生存期38个月，1、3、5年生存率分别为85.6％、50.6％和38．7％。Ⅰ、Ⅱ和Ⅲ期的5年生率分别为61.4％、40.2％和29.9％（P=0.001），男性和女性的5年生存率分别为33．7％和56.5％（P=0．042），有或无淋巴结转移的5年生存率分别为32.5％和59.6％（P=0．001），有或无脉管瘤栓5年生存率分别为21％和46％（P=0．001）。COX回归多因素分析显示TNM分期、性别、脉管瘤栓、淋巴结转移和化疗周期数为独立的预后因子。结论TNM分期仍是小细胞肺癌术后化疗的重要预后因子，性别、脉管瘤栓、化疗周期数也是影响预后因子。

Objective To explore the survival time of the patients with small cell lung cancer （SCLC） treated with postoperative chemotherapy and the factors affecting the prognosis. Methods The clinical data of 111 patients treated with postoperative chemotherapy, 88 males and 23 females, aged 57 （32 -81 ）, were reviewed retrospectively. Results The overall median survival time （MST） was 38 months, and the 1-, 3-, and 5 year survival rates were 85.6%, 50.6%, and 38.7% respectively. The 5 year survival rates of the patients at the stage Ⅰ was 61.4%, significantly higher than those of the patients at the stages Ⅱ and Ⅲ （40.2% and 29.9% respectively, both P =0. 001 ）. The 5 year survival rate of the male patients was 33.7%, significantly lower than that of the female patients （56.5%, P = 0.042）, the 5 year survival rate of the patients with lymph node metastasis was 32.5%, significantly lower than that of the patients without lymph node metastasis （59.6%, P =0.001 ） ; and 5 year survival rate of the patients, with lymphovascular invasion was 21%, significantly lower than that of the patients without lymphovascular invasion （46%, P = 0. 001 ）. Cox＇s multivariate analysis identified TNM stage, lymphovascular invasion, sex, lymph node metastasis, and chemotherapy cycles as independent prognostic variables. Conclusion For SCLC treated with postoperative chemotherapy, TNM stage system is an important prognostic factor; and sex, lymphovascular invasion, lymph node metastasis, and chemotherapy cycles also affect the survival outcome.