单中心394例广泛期小细胞肺癌的一线化疗及生存分析

First-line Chemotherapy and Its Survival Analysis of 394 Patients with Extensive- stage Small Cell Lung Cancer in a Single Institute

背景与目的小细胞肺癌(small cell lung cancer,SCLC)是恶性程度极高的神经内分泌肿瘤,对放化疗敏感。目前,广泛期SCLC的一线标准化疗方案为铂类联合依托泊苷方案,但大多数接受一线化疗的患者在年-2年内复发。一旦疾病复发,预后不良。本研究旨在研究广泛期SCLC总体和一线化疗的生存情况及其影响因素。方法收集200年2月-20年2月经病理学或细胞学确诊为广泛期的SCLC患者394例,采用Kaplan-Meier法计算总生存时间(overall survival,OS)和无进展生存时间(progression-free survival,PFS)并绘制生存曲线,单因素及Cox回归多因素分析各种因素对生存期的影响。结果全组中位OS为4.8个月,年、2年、5年生存率分别为58.9%、27.2%、7.8%。全组OS与年龄(P=0.006)、ECOG评分(P=0.02)、肝转移(P<0.00)、骨转移(P<0.00)、是否化疗(P<0.00)密切相关。一线化疗广泛期SCLC患者的中位OS为5.个月,中位PFS为7.5个月。多因素分析结果显示一线化疗广泛期SCLC的OS与吸烟(P=0.04)、肝转移(P<0.00)、骨转移(P<0.00)、化疗疗程数(P<0.00)相关;一线化疗PFS与吸烟(P=0.003)、肝转移(P=0.00)、骨转移(P<0.00)、化疗疗程数(P<0.00)相关。胸部放疗并非广泛期SCLC OS和PFS的独立影响因素。结论年龄<60岁、体能状况好、无肝、骨转移的广泛期SCLC患者预后更好。广泛期SCLC患者应积极进行化疗,一线化疗的化疗疗效达到部分缓解-完全缓解有益于生存;适合的化疗疗程数目是4-6疗程。胸部放疗在广泛期SCLC治疗中的作用需要进一步研究。

Background and objective Small cell lung cancer （SCLC） is the most malignant neuroendocrine tumor but highly sensitive to chemotherapy and radiotherapy. At present, the standard first-line chemotherapy regimen of extensive- stage SCLC is platinum combined etoposide regimen. However, most patients who receive first-line chemotherapy will relapse within one to two years. Once recurrent, it indicates poor prognosis. In this study, we analyzed the survival among all extensive- stage SCLC and patients who received first-line chemotherapy and determined prognostic factors. Methods Total of 394 patients who were diagnosed as extensive-stage small cell lung cancer from February 2001 to December 2011 hospitalized in Peking Union Medical College Hospital were collected. Kaplan-Meier method was used to calculate the overall survival （OS） and progression-free survival （PFS）. Univariate analysis and Cox regression analysis were used to detect the influence factors of survival, Results The median OS of all extensive-stage small cell lung cancer was 14.8 months~ 1-year, 2-year and S-year survival rates were 58.9%, 27.2% and 7.8%, respectively. According to the results of univariate and Cox multivariate analysis, OS of extensive-stage SCLC was closely associated with age （P=O.O06）, ECOG PS （P=0.021）, liver metastasis （P〈0.001）, bone metastasis （P〈0.001） and chemotherapy （P〈0.001）. The mortality risk of patients who didn＇t receive chemotherapy was 4.919 times higher than that who received; the mortality risk of patients without liver, bone metastasis was reduced by approximately50 percent. The first-line chemotherapy was mainly EP （DDP＋VP-16） or CE （CBP＋VP-16） regimens （accounting for 82.8%） with 4-6 cycles. The median OS and PFS in first-line chemotherapy were 15.1 months and 7.5 months, respectively. The result of Cox regression analysis indicated that OS in first-line chemotherapy was remarkably related to smoking history （P=0.041）, liver metastasis （P〈O.O01）, bone metastasis （P〈O.O01）, chemotherapy cycle number （P〈O.O01）; PFS was relevant with smoking history （P=0.003）, liver metastasis （P=0.001）, bone metastasis （P〈0.001）, chemotherapy cycle number （P〈0.001）. Thoracic radiotherapy was not an independent influence factor of OS and PFS in extensive-stage small cell lung cancer. Con- clusion The patients who were younger than 60-year old, with good KPS, absence of liver and bone metastasis had better prognosis. Patients should receive chemotherapy with first-line standard regimen （CE/EP regimen）. It was beneficial to sur- vival if the effect of first-line chemotherapy was SD or PR-CR and the proper chemotherapy cycle number was 4-6 cycles. The role of thoracic radiotherapy in extensive-stage small cell lung cancer needed to be investigated further.