姑息性放疗对Ⅳ期非小细胞肺癌患者预后的影响

Impact of palliative radiotherapy to the prognosis of patients with stage IV non-small cell lung cancer

目的探讨姑息性放疗对Ⅳ期非小细胞肺癌（NSCLC）患者预后的影响。方法收集我院Ⅳ期NSCLC患者244例，其中129例（研究组）化疗后对原发灶及转移灶姑息性放疗，115例（对照组）单纯化疗，随访比较其1、2年生存率并探讨影响姑息性放疗效果的因素。结果研究组患者随访2年16例生存，110例死亡，失访3例，中位生存时间为8个月，1、2年生存率分别为29．46％（38／129）、12．40％（16／129），对照组7例生存，106例死亡，2例失访，中位生存时间6个月，1、2年生存率分别为11．30％（13／115），6．09％（7／115），两组生存率比较差异有统计学意义（X2=8．451，P=0．014）；单因素分析发现，影响Ⅳ期NSCLC患者姑息性放疗预后的因素包括KPS评分（x2=5．057，P=0．031）、是否发生脑转移（X2=4．781，P=0．029）、转移器官个数（x2=6．341，P=0．010）、原发灶放疗剂量（X2=5．893，P=0．015）；COX回归模型分析发现转移器官个数（HR=1．719，95％CI为1．172—3．126，P=0．008）、原发灶放射剂量（HR=1．560，95％CI为1．082～2．761，P=0．022）是影响预后的独立因素。结论姑息性放射治疗在Ⅳ期NSCLC治疗中起到了延长生存期的作用。姑息性放疗需注意对原发灶及转移灶剂量的控制，从而延长患者生存时间。

Objective To investigate the impact of palliative radiotherapy to the prognosis of patients with stage IV non-small cell lung cancer （NSCLC）. Methods Two hundred and forty-four cases of stage IV NSCLC were collected from our hospital. The study group （n = 129） received the treatment of primary tumor and metastases palliative radiotherapy after chemotherapy. The control group （n = 115 ） received only chemotherapy. Followed-up and compared 1-year and 2-year survival rate of the patients, and explored the factors affecting palliative radiotherapy. Results The 129 patients in the study group were followed up for 2 years, and 16 patients survived and 110 patients died. Three patients were lost to follow-up. The median survival time was 8 months. 1-year and 2-year survival rates was 29.46% （38/129） and 12. 40% （16/129） respectively In the control group, 7 patients survived, and 106 patients died. Two patients were lost to follow up. The median survival time was 6 months. 1-year and 2-year survival rates was 11.30% （ 13/115 ） and 6. 09% （7/115） respectively. Survival rates between the two groups were significantly different （x5 = 8.451, P = 0. 014 ） Univariate regression analysis found that factors affecting the prognosis of stage IV NSCLC were KPS score （ X2 = 5. 057, P = 0. 031 ）, occurrence of brain metastases （ x2 = 4. 781, P = 0. 029）, number of organs of metastasis （ X2 = 6. 341 ,P = 0. 010）, and the primary stove radiotherapy dose （x2 = 5. 893, P = 0. 015 ） ; Cox regression model analysis showed that the number of organs of metastasis （HR = 1. 719,95% CI 1. 172 - 3. 126,P = 0. 008）, the primary focal radiotherapy dose （ HR = 1. 560,95% CI % 1. 082 - 2. 761, P = 0. 022 ） were independent prognostic factors. Conclusion Palliative radiotherapy plays a role of prolonging survival time in the treatment of IV NSCLC. In palliative radiotherapy, we should pay attention to the control of the primary tumor and metastases radiotherapy dose, therefore orolonging the survival time of oatients.