早期非小细胞肺癌伽玛刀治疗预后影响因素分析

Analysis of prognostic factors for early non-small-cell lung cancer after γ knife therapy

目的：分析早期非小细胞肺癌（non-small-cell lung cancer,NSCLC）伽玛刀治疗的疗效及预后影响因素。方法：收集不能或不愿手术的早期NSCLC患者150例。其中鳞状细胞癌104例,腺癌32例,其他病理类型肺癌14例。利用γ射线立体定向放射治疗系统放疗150例,每次剂量4~5Gy,50%剂量线覆盖PTV为参考剂量,1次/d,共10次,总剂量40~50Gy。Kaplan-Meier法和Log-rank法比较生存率,Cox回归分析法进行多因素分析。结果：全组中位生存时间36个月,总1、3、5年生存率分别为87.7%、43.9%、22.7%。单因素分析显示：不同Karnofsky评分（χ~2=18.82,P=0.000）、临床分期（χ~2=8.78,P=0.004）、肿瘤直径（χ~2=8.09,P=0.009）、近期疗效（χ~2=14.62,P=0.000）对生存影响差异有统计学意义。多因素回归分析显示放射治疗前Karnofsky评分（χ~2=11.35,P=0.001）和肿瘤直径（χ~2=4.84,P=0.027）是影响早期NSCLC患者预后的独立因素。结论：放疗前Karnofsky评分、肿瘤直径对早期NSCLC患者γ-刀放射治疗的预后可能产生明显影响。

Objective： To evaluate the prognosis influencing factors of early non-small-cell lung cancer（ NSCLC） after γ knife treatment. Methods： All 150 cases of early-stage NSCLC patients who can not or do not want to surgery were collected,among these patients,104 were diagnosed as squamous cell carcinoma,32 adenocarcinoma,14 other pathological types of lung cancer. γ knife stereotactic body radiotherapy system（ SBRT） was used to treat these cases. Each dose 4 ~ 5Gy,the reference dose was the dose whose 50% lines cover PTV,1 time / day,a total of 10 times,a total dose of 40 ~ 50 Gy. Kaplan-Meier survival curves and Cox regression model analysis were applied to evaluate the survival and prognostic factors. Results： The median survival time was 3 6 months. The 1,3 and 5-year survival rates（ OS） were 87. 7%,43. 9%,22. 7%,respectively. Karnofsky performance status（ χ~2= 18. 82,P= 0. 000）. clinical stage（ χ~2= 8. 78,P = 0. 004）,diameter≤4 cm and the therapeutic effect were associated with improving overall survival. Cox hazards model showed that Karnofsky performance status≥80 and diameter≤4cm were independent positive prognostic factors. Conclusion： Karnofsky performance status and tumor diameter can be used to evaluate early NSCLC after γ knife treatment.