放射治疗非小细胞肺癌的预后因素分析

Prognostic factors of radiation treated non small cell lung cancer.

目的回顾性分析根治性放射治疗的非小细胞肺癌（ＮＳＣＬＣ）病例，探讨影响放射治疗非小细胞肺癌预后的因素。方法选择１９９０年１月～１９９６年１２月间根治性放射治疗并经病理确诊的Ⅰ～Ⅲｂ期ＮＳＣＬＣ患者２５６例，生存统计采用ＫａｐｌａｎＭｅｉｅｒ法及Ｌｏｇｒａｎｋ检验，多因素分析采用Ｃｏｘ逐步回归模型。以多因素分析时各因素的变异系数乘以分组值计算预后指数。结果全组中位生存时间１４．５个月，１，３，５年生存率分别为６０％，２１％和７％。单因素和多因素分析均显示临床分期早；在较短的总疗程时间内接受较高剂量的照射；病理类型为鳞癌和放射治疗前细胞免疫状态较好的患者预后较好。综合以上４种因素的预后指数模型能够较好地区分不同的预后亚组。结论临床分期、放射治疗方法、病理类型和放射治疗前细胞免疫状态是放射治疗ＮＳＣＬＣ的独立预后因素。预后指数模型能够比ＴＮＭ分期等单个因素更好地反映预后。

Objective A retrospective analysis was carried out to evaluate the prognostic factors of irradiated non small cell lung cancer (NSCLC). Methods From Jan. 1990 to Dec. 1996, 256 patients with Stage Ⅰ～Ⅲb NSCLC were treated and eligible for the analysis. All patients received definitive radiotherapy. The significance of prognostic variables in the survival was evaluated by univariate analysis and Cox stepwise regression model. The prognostic index was calculated according to the value of each prognostic factor in the survival. Results The overall median survival was 14.5 months, and 1 , 3 and 5 year actuarial survivals were 60%, 21% and 7%, respectively. Univariate and multivariate analyses showed that patients with early lesion, squamous carcinoma, good status of cellular immunology before radiotherapy and higher total dose over shorter overall treatment course gave better survival. Conclusions Clinic stage, method of radiotherapy, pathologic type and cellular immune status before radiotherapy are independent prognostic factors. Prognostic index model is able to predict the prognosis of NSCLC treated with radiation therapy more effectively than single variable such as TNM stage.