1,742例Ⅳ期非小细胞肺癌的预后分析

Survival Analysis of 1,742 Patients with Stage Ⅳ Non-small Cell Lung Cancer

背景与目的目前非小细胞肺癌(non-small cell lung cancer,NSCLC)仍是导致癌症死亡的首要原因,本研究旨在探讨影响晚期NSCLC预后的重要因素。方法收集2000年1月4日-2008年12月25日1,742例IV期NSCLC临床资料,所有病例经细胞学或组织病理学确诊。分析性别、年龄、吸烟史、病理类型、分型、临床TN分期、转移器官数目、治疗方法对预后的影响,应用Kaplan-Meire方法计算生存率,Log-rank检验生存率差别,采用Cox多因素回归对预后因素进行分析。结果本组1,742例患者的中位生存期为10.0个月(9.5个月-10.5个月),1年、2年、3年、4年、5年生存率分别为44%、22%、13%、9%、6%。单器官发生转移与多器官转移中位生存期分别为11个月vs7个月(P<0.001)。不同器官发生转移后生存期不同,中位生存期分别为肺12个月(11.0个月-12.9个月),骨9个月(8.3个月-9.6个月),脑8个月(6.8个月-9.1个月),肝、肾上腺、远处淋巴结转移均为5个月(3.8个月-6.1个月),皮下3个月(1.7个月-4.3个月)。腺癌患者1,086例(62%),鳞癌305例(17.5%),中位生存期分别为12个月vs8个月(P<0.001)。化疗与最佳支持治疗者中位生存期分别为11个月vs6个月(P<0.001)。放疗与否的中位生存期分别为11个月vs9个月(P=0.017)。结论性别、年龄、大体分型、病理类型、临床T分期、N分期、转移器官数目、吸烟史、治疗方法是晚期NSCLC预后的独立影响因素。

Background and objective At present non-small cell lung cancer（NSCLC） is still the leading cause of death induced by cancer. The aim of this study is to investigate the prognostic factors of advanced NSCLC. Methods Total 1,742 cases of stage IV NSCLC data from Jan 4,2000 to Dec 25,2008 in Shanghai Chest Hospital were collected,confirmed by pathological examinations. Analysis was made to observe the impact of treatment on prognosis in gender,age,smoking history,pathology,classification,clinical TNM stage. Survival rate,survival difference were evaluated by Kaplan-Meire method and Log-rank test respectively. The prognosis were analyzed by Cox multivariate regression. Results The median survival time of 1,742 patients was 10.0 months（9.5 months-10.5 months） . One,two,three,four,and five-year survival rates were 44%,22%,13%,9%,6% respectively. The median survivals of single or multiple metastasis were 11 months vs 7 months（P0.001） . Survival time were different in metastasic organs,with the median survival time as follows： lung for about 12 months（11.0 months-12.9 months） ,bone for 9 months（8.3 months-9.6 months） ,brain for 8 months（6.8 months-9.1 months） ,liver,adrenal gland,distannt lymph node metastasis for 5 months（3.8 months-6.1 months） ,and subcutaneous for 3 months（1.7 months-4.3 months） . The median survival times of adenocarcinoma（n=1,086,62%） and squamous cell carcinoma cases（n=305,17.5%） were 12 months vs 8 months（P0.001） . The median survival time of chemotherapy and best supportive care were 11 months vs 6 months（P0.001）;the median survival times of with and without radiotherapy were 11 months vs 9 months（P=0.017） . Conclusion Gender,age,gross type,pathological type,clinical T stage,N stage,numbers of metastatic organ,smoking his-tory,treatment of advanced non-small cell lung cancer were independent prognostic factors.