术前肺通气功能对非小细胞肺癌术后生存的预测意义

Prognostic Significance of Preoperative Pulmonary Ventilation Function Test for Postoperative Survival of Patients with Primary Non-small Cell Lung Cancer

目的探讨术前肺通气功能检查对评估非小细胞肺癌(NSCLC)患者手术后生存的意义。方法以2003年1月1日至2008年12月31日在南京大学医学院附属鼓楼医院行肺癌根治术的146例NSCLC患者为研究对象,评估术前肺通气功能各指标如肺活量(VC)、用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、FEV1/FVC、呼气峰流速(PEF)对NSCLC术后生存的影响。采用单因素和多因素Cox比例风险回归模型评估各指标对患者死亡风险度的影响,采用Kaplan-Meier检验比较各组间生存率。结果 NSCLC患者手术后中位生存期为31.0个月。VC、FVC、FEV1三者的实测值占预计值百分比(%)被证实为影响NSCLC患者术后生存的独立预后因素(HR值0.979～0.981,P均<0.05)。VC≤预计值80%与>预计值80%的中位生存时间分别是31.0个月和34.0个月,FVC≤预计值80%与>预计值80%的中位生存时间分别是27.0个月和43.0个月,FEV1≤预计值80%与>预计值80%的中位生存时间分别是17.0个月和44.0个月,各组间生存率差异均有统计学意义(P均<0.05)。结论开胸手术前肺通气功能指标(VC、FVC、FEV1三者的实测值占预计值%)可能对NSCLC患者手术后的生存有预测作用。

Objective To explore the prognostic value of preoperative pulmonary ventilation function for postoperative survival of patients with non-small cell lung cancer （NSCLC）. Methods 146 NSCLC patients who underwent cured lung surgical resection between January 1,2003 and December 31, 2008 in Nanjing Drum Tower Hospital were recruited in the study. Pulmonary ventilation function was obtained preoperatively for each patient, including vital capacity （ VC ）, forced vital capacity （ FVC）, forced expiratory volume in 1 second （ FEV1）, FEV1/FVC, and peak expiratory flow （PEF）. The effects of the above lung function variables on postoperative survival were evaluated by both univariate and multivariate Cox proportional hazard models. Kaplan-Meier method was used to assess the survival probabilities between different groups. Results The median survival time after surgery was 31.0 months （ 95% CI 22. 55- 39. 45 ）. VC% pred, FVC% pred and FEV1% pred showed significant associations with the risk of mortality in the NSCLC patients after surgery （ hazard ratios 0. 979-0. 981 ,P 〈 0. 05 ）. The survival time after surgery was significantly shorter in the patients with VC ≤ 80% predicted compared to those with VC 〉 80% predicted （median survival time： 31.0 months vs. 34.0 months ）. The same difference could be found between the patients with FVC ≤ 80% predicted and those with FVC 〉 80% predicted （ median survival time ：27.0 months vs. 43.0 months）. There was also significant difference in median survival between the patients with FEVI ≤ 80% predicted and those with FEV, 〉 80% predicted （ median survival time ： 17. 0 months vs. 44.0 months ）. Conclusion Preoperative pulmonary ventilation function parameters may be used to inform clinical decisions and indicate the prognosis of NSCLC patients after surgery.