原发灶不明肿瘤患者预后影响因素的分类及回归树分析

Classification and regression tree analysis of 154 patients with cancer of unknown primary

目的 探讨原发灶不明肿瘤患者的预后影响因素.方法 收集154例原发灶不明肿瘤患者的临床和随访资料,采用分类及回归树分析（CART）建立生存树.结果 154例原发灶不明肿瘤患者的中位生存时间（MS）为18.2个月,5年生存率为1.3%.CART分析将年龄34岁作为第1个划分位点,逐级划分后获得了5个末端结,即5个终末亚组.生存时间最长的是年龄为35～60岁、受累器官数目≤2个的非腺癌亚组,其MS为61.8个月.生存时间最短的是年龄≤34岁亚组,其MS为5.5个月.结论 患者年龄、转移器官数目和病理类型与原发灶不明肿瘤患者的生存时间关系密切.回归树分析可以找出既往被忽略的原发灶不明肿瘤亚组患者,这对临床工作具有重要的指导意义,并将有利于今后开展相关的临床研究.

Objective To explore the prognostic factors and their impact on survival of patients with cancer of unknown primary （CUP）. Methods The clinical and follow up data of 154 CUP patients referred to the Cancer Hospital ＆ Institute, Chinese Academy of Medical Sciences from January 1,2003 to December 31,2007 were analyzed. Multivariate analysis of survival was performed using recursive partitioning referred to as classification and regression tree （CART） analysis. Results The median survival for 154 eligible consecutive CUP patients was 18.2 months, and the 5-year survival rate was 1.3%. CART was performed with an initial split on age of 34, and 5 terminal subgroups were formed. The median survival of the 5 subsets ranged from 5.5 months （younger than 34 years old subgroup） to 61.8 months for patients at age of 34 to 60, with one or two organ sites involved, and non-adenocarcinoma histology subsets. Conclusions CART can be used to identify previously unappreciated patient subsets and is a useful method for dissecting complex clinical situations and identifying homogeneous patient populations in clinical practice and future clinical trials.