非小细胞肺癌三维适形放射治疗预后的多因素分析

Prognostic Factors of Non-small Cell Lung Cancer after Three-dimensional Conformal Radiotherapy

目的:探讨非小细胞肺癌三维适形放疗的预后影响因素,提供适形治疗计划的评价指标。方法:收集2000年8月至2004年12月河北医科大学第四医院放疗科接受三维适形放疗的非小细胞肺癌患者107例,其中鳞癌46例,腺癌21例,针吸活检或气管镜刷片发现癌细胞33例,未获得病理确诊但经影像学检查临床诊断肺癌7例。全程三维适形放疗48倒,59例前程行传统常规放疗、后程行三维适形放疗。全组患者总剂量60～78Gy,中位剂量66Gy。Kapian-Meier法计算生存率,采用COX逐步回归模型进行多因素分析。结果:随访日期截止于2007年12月31日,失访5例,随访率95.33%,失访患者生存期计算至末次随访日。全组患者中位生存期13个月,平均生存期24个月,1、2、3年生存率分别为55.14%、34.58%、21.50%。单因素分析显示患者性别、吸烟、肿瘤最大直径、肿瘤体积.N分期、临床分期、近期疗效、GTV体积、CTV体积、PTV体积对生存率均有显著性影响。多因素分析显示患者性别、N分期、肿瘤体积、近期疗效、GTV体积为NSCLC的独立性预后因素。结论:患者性别、N分期、肿瘤体积、近期疗效、GTV体积对NSCLC三维适形放射治疗的预后可能产生明显影响。

Objective： A retrospective analysis was carried out to evaluate the prognosis of NSCLC after radiotherapy. Methods： From August 2000 to December 2004, 107 NSCLC patients received definitive radiotherapy and were eligible for our study. Among these patients, 46 cases were squamous cell carcinoma, 21 cases were adenocarcinoma, 33 cases were found to have cancer cells and 7 cases were diagnosed through imaging instead of pathology. Forty-eight patients received three dimensional conformal radiotherapy （3D-CRT）, and the other 59 patients received conventional radiotherapy （CRT） before later-course 3D-CRT. All of the patients received a total dose of 60-78Gy with a median dose of 66Gy. Kaplan-Meier survival curves and Cox regression model analysis were used to evaluate the survival and prognostic factors. Results： The investigation was finished at the end of 2007, with a follow-up rate of 95.5%. The median survival time was 13 months and the mean survival time was 24 months. The 1-, 2- and 3-year survival rates （OS） were 55.14%, 34.58% and 21.50%, respectively. Gender, cigarette smoking, tumor maximum diameter, tumor volume, N stage, clinical stage, the therapeutic effect, and the volume of GTV, CTV, and PTV were important prognostic factors. Cox hazards model showed that gender, N stage, tumor volume, therapeutic effect and GTV volume were likely to be independent prognostic factors. Conclusion： Gender, N stage, tumor volume, therapeutic effect, and GTV volume can be used to evaluate the prognosis of NSCLC after 3D-CRT.