小细胞肺癌住院病例生存情况与预后影响因素分析

Analysis on survival status of inpatients with small cell lung cancer and influencing factors of prognosis

目的对湖南省某三甲医院小细胞肺癌住院病例临床资料进行生存分析,筛选出可能影响小细胞肺癌患者预后的影响因素,为临床治疗与防控提供重要的科学数据。方法收集湖南省某三甲医院2001-2005年小细胞肺癌住院病例的临床资料。采用SPSS19.0进行数据分析,利用寿命表(life table)法和Kaplan-Meier法估计生存率(survival rate)和中位生存时间(median survival time,MST),并绘制生存函数曲线;用对数秩和检验(Log-rank)法分析各组因素反映在生存时间上的差异是否具有统计学意义;最后利用Cox比例风险模型筛选出影响小细胞肺癌住院病例预后的主要影响因素。结果随访2001年1月-2005年12月在湖南省某三甲医院住院治疗的341例小细胞肺癌病例,随访截止时间为2010年12月31日。随访结局生存40例,中途失访2例,完全失访3例,死亡296例。随访应答率为98.53%,数据删失比例为12.9%。全组患者MST为19.65个月,1年、2年、3年和5年生存率分别为67%、40%、32%和16%。单因素分析显示性别、吸烟、喝酒、症状出现至首次治疗开始时间间隔、体重下降、临床分期、是否手术、是否联合治疗、首治疗效等对小细胞肺癌患者预后影响差异有统计学意义(P<0.05)。Cox比例风险模型分析显示性别、吸烟、疾病临床分期、是否联合治疗是小细胞肺癌住院病例预后的主要影响因素。结论性别、吸烟、临床分期、是否联合治疗是影响小细胞肺癌预后的主要影响因素。湖南省某三甲医院2001-2005年小细胞肺癌住院病例生存率与同期国内外文献报道比较,已经达到或略超过同级医院水平。

Objective A survival analysis was conducted on inpatients with small cell lung cancer （SCLC） hospitalized in a 3A -grade hospital in Hunan Province to explore the factors that might affect the prognosis of SCLC,and to provide important scientific references for clinical treatment,prevention and control of SCLC.Methods The clinical data of inpatients diagnoscd with SCLC from a 3A-grade hospital in Hunan Province during 2001 and 2005 were collected and statistically analyzed by SPSS19.0 software.Life-table method and Kaplan-Meier analysis were used to estimate the survival rate and median survival time（MST）.The survival function curve was drawed.Log-rank test was used to analyze whether there existed statistical differences in survival period among different groups.COX proportional hazards model was used for screening the main influencing factors of the prognosis of the inpatients with SCLC.Results In total,341 inpatients with SCLC treated in the hospital from January 2001 to December 2005 were followed up.To the end of the follow-up,December 31,2010,40 of them still survived,and 2 cases failed to be followed-up midway,and 3 cases completely failed to be followed up and 296 died of SCLC.The follow -up response rate was 98.53%.The data deletion and loss rate was 12.9%.The MST of all the patients was 19.65 months.The 1-year,2-year,3-year and 5-year survival rates were 67%,40%,32% and 16% respectively.Univariate analysis indicated that gender,smoking,drinking alcohol,the interval between first appearance of symptoms and the first treatment initiation,weight loss,clinical stage,operation,combined therapy and efficacy of the first treatment were factors significantly influencing the prognosis of the inpatients with SCLC （P 〈 0.05）.And the COX-proportional hazards model analysis suggested that gender,smoking,clinical stage and combined therapy were main influenciong factors （P 〈 0.05）.Conclusions Gender,smoking,clinical stage and combined therapy are the main influencing factors affecting the prognosis of the patients with SCLC.The survival rates of the inpatients with SCLC in the 3A-grade hospital in Hunan Province from January 2001 to December 2005 reach,or slightly surpass those in other 3A-level hospitals both in China and overseas during the same period.