112例小细胞肺癌患者多因素生存分析

Multivariate analysis of prognostic factors in 112 patients with small cell lung cancer.

目的分析小细胞肺癌患者预后的影响因素。方法收集112例经组织病理学或细胞学明确的小细胞肺癌患者临床资料，分析性别、年龄、分期、血红蛋白水平、乳酸脱氢酶水平、一线化疗疗效、放疗及手术治疗等因素与患者生存期的关系，采用Kaplan—Meier法生存分析，进行Log-rank非参数检验，用COX比例风险模型进行多因素生存分析。结果全组患者1、2、3年生存率分别为71．4％、38．4％和14．3％，其中局限期1、2、3年生存率分别为80．0％、47．1％和17．1％，广泛期1、2、3年生存率分别为57．1％、23．8％和9．5％。全组中位生存时间为22个月，其中局限期生存时间24个月，广泛期生存时间16个月。单因素分析发现分期、血红蛋白水平、乳酸脱氢酶水平、一线化疗疗效、放疗及手术治疗均可影响患者的生存期。多因素分析则提示分期、一线化疗疗效、放疗及手术治疗是患者生存的独立影响因素，其相对危险度分别为0．687、0．635、0．412、0．203。结论分期、化疗疗效、是否接受放疗及手术治疗可能是影响小细胞肺癌患者预后的主要因素。

Objective To analyze the prognostic factors in patients with small cell lung cancer （SCLC）. Methods Clinical data of 112 patients with small cell lung cancer diagnosed by histopathology or Cytology were collected. The relationship between gender, age, stage, the level of Hemoglobin （Hb） and lactate dehydrogenase （ LDH）, the efficacy of first -line chemotherapy, radiotherapy and operation with the survival time was analyzed. Kaplan-Meier , COX multivariate proportional hazards model and Log-rank test were used to analyze the prognostic factors. Results 1, 2, and 3 year survival rate was 71.4% , 38.4% and 14.3% respectively,80.0% ,47.1% and 17.1% in limited disease （LD） patients, 57.1% ,23.8% and 9.5% in extensive disease （ED） patients. Median survival time （MST） of all the patients was 22 months, 24 months in LD, and 16 months in ED. Univariate analysis indicated that stage, Hb, LDH, the efficacy of first-line chemotherapy, radiotherapy and operation significantly in- fluenced survival in SCLC. Multivariate analysis suggested that stage, the efficacy of first-line chemotherapy, radiotherapy and operation were the independent prognositic factors of survival （ relative risk degree = 0. 687, 0. 635, 0.412, 0. 203）. Conclusion Stage, efficacy of first-line chemotherapy, radiotherapy and operation are the important prognostic factors for patients with SCLC.