大细胞肺癌患者预后影响因素及术后CIK治疗疗效的分析

Prognostic factors and efficacy of CIK on post-surgery large cell lung cancers

目的:探讨大细胞肺癌(1arge cell lung cancer,LCLC)患者的预后影响因素及术后不同治疗方式的疗效差异。方法:回顾性分析2000年1月至2009年12月行手术治疗的80例LCLC患者的临床资料,采用单因素和多因素方法分析预后的影响因素及术后不同治疗方式的临床疗效。结果:80例LCLC患者术后临床分期:Ⅰ期21例,Ⅱ期22例,Ⅲ期28例,Ⅳ期9例。29例患者术后未行任何全身治疗,35例行单纯化疗,5例行IFN-α联合化疗,11例行细胞因子诱导的杀伤细胞(cytokine-induced killercell,CIK)联合化疗。80例LCLC患者1、3、5年生存率分别为72.5%、45.6%、31.0%。单因素分析显示,N分期(P=0.002)、M分期(P<0.001)、临床分期(P<0.001)、手术方式(P=0.001)、术后不同治疗(P<0.001)与患者预后相关。多因素分析显示,临床分期(P<0.001)、手术方式(P=O.034)、术后不同治疗(P=0.001)是LCLC患者预后的独立影响因素。通过对不同治疗方式组的生存期进行分析,单纯化疗组、CIK联合化疗组与无治疗组的生存期差异均具有统计学意义(均P<0.05)。对43例Ⅰ/Ⅱ期LCLC患者进行分析后发现,CIK联合化疗组分别与无治疗组、单纯化疗组之间生存期差异具有统计学意义(P=0.004.0.044);对37例Ⅲ/Ⅳ期患者的生存期进行分析后发现,单纯化疗组、以CIK联合化疗组、IFN-α联合化疗组患者生存与无治疗组患者生存差异均具有统计学意义(P=0.012、0.041、0.011)。结论:影响LCLC患者预后的独立因素是临床分期、手术方式、术后治疗方式;早晚期LCLC患者接受术后治疗均可获益,且CIK联合化疗组疗效优于单纯化疗组。

Objective： To investigate the prognostic factors of large cell lung cancer （LCLC） and analyze the efficacy of different postoperative therapeutic strategies on surgery-LCLC. Methods： To collect and retrospectively analyze the clinical data of 80 surgery-LCLC cases between 2000.1 and 2009.12. The prognostic factors and efficacy of different postoperative therapeutic strategies were evaluated by univariate and multivariate analyses. Results： All the 80 cases were diagnosed as stage Ⅰ （21） , stage Ⅱ （22） , stage Ⅲ （28） and stage Ⅳ （9）. 29 cases received no systemic treatment after surgery, 35 received routine chemotherapy, 5 received IFN-α combined with chemotherapy and 11 received cytokine-induced killer cells（CIKs） combined with chemotherapy. The overall 1-, 3- and 5-year survival rates of the 80 LCLC cases were 72.5%, 45.6%, 31.0% , respectively. Cox univariate analysis revealed that N stage （P =0. 002）, M stage （P 〈 0. 001 ）, the clinical stage （P 〈0. 001 ）, surgical methods （P =0. 001 ） and different postoperative therapeutic strategies （P 〈 0.001 ） were prognostic factors. Cox multivariate analysis indicated that the clinical stage （ P 〈 0. 001 ）, surgical methods （P = 0. 034）, different postoperative therapeutic therapies （P = 0. 001 ） were independent prognostic factors. Further analysis revealed that the overall survival of patients with chemotherapy alone or CIK combined with chemotherapy were significantly higher than those without any postoperative therapy （ all P 〈 0.05 ）. After analyzing 43 phase I / II LCLC cases, we found that the patients undergoing CIK combined with chemotherapy had a better survival than did those without any postoperative treatment or with chemotherapy alone （P = 0. 004, 0. 044, respectively）. Analysis of phase Ⅲ/Ⅳ 37 cases revealed that the overall survivals of patients recieving chemotherapy alone or IFN-ot combined with chemother- apy, CIK combined with chemotherapy were significantly higher than those without any postoperative therapy （P = 0. 012, 0. 041, 0.011, respectively）. Conclusion： The clinical stage, surgical methods, postoperative therapy strategies are independent prognostic factors for LCLC patients. For early or advanced stage LCLC cases, postoperative therapy is also required, with CIK combined chemotherapy superior to chemotherapy alone