螺旋断层放疗治疗转移性非小细胞肺癌的预后分析

Prognostic analysis of metastatic non-small cell lung cancer patients treated with helical tomotherapy

目的探讨转移性非小细胞肺癌（NSCLC）患者接受螺旋断层放疗后的预后情况及其影响因素。方法对本院2011年6月至2013年2月采用螺旋断层放疗技术治疗的51例转移性NSCLC患者的临床资料进行回顾性分析。所有靶区的中位放疗剂量为42.5 Gy（30~62 Gy）,单次放疗的中位剂量2 Gy（1.8~3 Gy）。应用Kaplan-Meier法计算生存率,Log-rank检验比较组间的生存差异,Cox风险比例回归模型分析影响预后的各种因素。结果所有患者随访时间均超过1年。51例转移性NSCLC患者的中位生存时间为19.3个月,1年生存率为64.7%。单因素分析显示,KPS评分高、病理类型为腺癌、放疗前接受过化疗、无肝转移和所有病灶计划靶区体积（PTV）≤1300 cm3是NSCLC患者预后良好的影响因素（P〈0.05）;Cox多因素分析显示KPS评分、放疗前是否化疗和所有病灶PTV是转移性NSCLC患者采用螺旋断层放疗的独立预后因素。结论转移性NSCLC采用螺旋断层放疗对延长患者的生存时间及改善预后可能有重要意义。

Objective To investigate the prognosis and influential factors in metastatic non-small cell lung cancer（NSCLC）treated with helical tomotherapy.Methods The clinical data of fifty-one cases of metastatic NSCLC treated by helical tomotherapytechnology were collected in our center, from June 2011 to February 2013. Radiation to all the target volume was delivered to a mediandose of 42. 5 Gy（30-62 Gy） with a median daily dose of 2 Gy（1. 8-3 Gy）. The Kaplan-Meier method was used for calculating overallsurvival rates. The Log-rank test was used for survival difference analysis. The Cox proportional hazards regression model was used formultivariate prognostic analysis.Results All the patients were followed up more than one year, the median survival time of fifty-onecases of metastatic NSCLC was 19. 3 months, the 1-year survival rate was 64. 7%. Univariate analysis showed that the higher KPSscore, adenocarcinoma, prior chemotherapy, without liver metastases and the plan target volume（PTV） ≤1300 cm3 were favorableprognostic factors for survival time in all patients. Multivariate analysis showed that the KPS score, prior chemotherapy and PTV wereindependent prognostic factors for metastatic NSCLC patients.Conclusion Helical tomotherapy may further prolong the survival timeand improve the prognosis for metastatic NSCLC patients.