高龄(≥70岁)早期非小细胞肺癌胸腔镜术后生存的预后因素分析

Analysis on Prognostic Factors of Long-term Outcomes in Elderly Patients with Early-stage NSCLC Treated by Video-assisted Thoracoscopic Surgery

目的 探讨影响高龄（≥70岁）Ⅰ期非小细胞肺癌（non—small cell lungcancer，NSCLC）患者术后生存的预后因素。方法回顾性分析2003年4月～2013年12月我院211例70岁及以上I期NSCLC的临床及随访资料，对影响术后生存的预后因素采用Kaplan．Meier生存分析、log-rank检验及Cox回归分析。结果中位随访时间39个月（0～93个月）。5年总生存率为66．9％，Kaplan—Meier生存分析和Cox单因素回归分析显示病变部位、病理分期、病变直径、分化程度、查尔森合并症指数（Chalsoncomorbidityindex，ccI）对总生存期存在影响。Cox多因素回归分析显示：病变部位（HR=3．946，95％C11．571～9．910）、病理分化（HR=2．003，95％C11．049—3．824）、肿瘤直径（HR=2．841，95％C11．478～5．462）及CCI（HR：3．920，95％CI1．767～8．698）是影响高龄早期肺癌患者术后生存的独立预后因素。结论对于早期高龄NSCLC患者，CCI、病变部位、分化程度、肿瘤直径是影响术后生存的重要预后因素。CCI对长期生存预后有一定的价值。加强术前综合评估有利于指导预后。

Objective To investigate prognostic factors of long-term survival in elderly patients with stage I non-small cell lung cancer （NSCLC）. Methods We conducted a retrospective review of clinical and follow-up data of 211 patients aged ≥70 years old with stage [ NSCLC April 2003 to December 2013 in our department. The Kaplan-Meier survival analysis, log-rank test,and Cox regression analysis were carried out to investigate the prognostic factors. Results The median follow-up time was 39 months （range, 0 - 93 months）. The 5-year overall survival rate was 66. 9%. The Kaplan-Meier survival analysis and Cox univariate regression analysis indicated that tumor location,pathological stage, tumor size, pathological differentiation, Chalson comorbidity index （CCI） were correlated to overall survival. The Cox muhivariate analysis demonstrated that tumor location （ HR = 3. 946, 95% CI 1.571 -9.910） , pathological differentiation （HR = 2. 003, 95% CI 1. 049 - 3. 824）, tumor size （HR = 2. 841, 95% CI 1. 478 - 5. 462） , and CCI （HR = 3. 920, 95% C1 1. 767 - 8. 698） were independent prognostic factors of postoperative long-term outcomes in elderly patients with early stage NSCLC. Conclusions For elderly patients with stage I NSCLC, the CCI, tumor location, pathological differentiation, and tumor size predicts a long-term survival. The CCI is of important value for predicting a long-term survival. Comprehensive preoperative assessment may benefit the prognostic estimation.