43例局限期小细胞肺癌术后预后分析

Prognosis Analysis in 43 Patients with Limited Stage Small Cell Lung Cancer after Surgery

目的对术后的局限期小细胞肺癌（SCLC）可能影响中位总体生存期（OS）的相关因素进行统计，分析其与预后的关系。方法收集笔者医院肿瘤科2010年1月～2014年10月收治的术后局限期SCLC患者，共43例。统计纳入患者的临床资料，包括性别、年龄、肿瘤位置、肿瘤最大直径、区域淋巴结转移、术前NSE水平、钠离子水平、D-二聚体水平和术后治疗方法等。采用电话形式进行随访，采用Kaplan—Meier曲线进行单因素生存分析，生存率比较采用Log-rank检验；将有统计学意义的变量，进入COX比例风险模型进行多因素生存分析。结果患者中位OS是20．0个月。由单因素分析显示，肿瘤最大直径（χ^2=6．345，P=0．042），术前NSE水平（χ^2=4．441，P=0．035）以及术后治疗方法（χ^2=8．793，P=0．012）对患者的中位OS有影响。多因素分析得出，术前NSE升高（OR=2．638）、术后未采取化疗±放疗（OR=1．938）是独立危险因素。结论在行手术治疗的局限期SCLC患者中，术前NSE升高，术后未治疗预后较差。在临床诊治中，应结合患者的具体情况，给予合适的综合治疗。

Objective To count up related factors which may influencing the median overall survival time of limited stage SCLC after surgery, and analyse the relationship between the factors and prognosis. Methods Totally 43 patients with limited stage SCLC after surgery who were treated in oncology department of our hospital from January 2010 to October 2014 were collected. Clinical data including gender, age, tumor position, maximum tumor diameter, regional lymph node metastasis, NSE, Na^＋, D- dimer level before surgery and treatment after surgery were analyzed. Follow up was performed by telephone, and the Kaplan - Meier curves were used to conduct univariate survival analysis, while survival rate was compared with Log - rank test ; and the statistically significant variables were conducted mult- ivariate survival analysis with COX proportional hazard model. Results The median survival time was 20.0 months. The univariate analysis showed that maximum tumor diameter（χ^2= 6. 345,P = 0. 042） , NSE level before surgery（χ^2 = 4. 441 ,P = 0. 035） and treatment after surgery（χ^2 = 8. 793,P = 0. 012） were related to survival time. The multivariate analysis showed that raised NSE level before surgery （ OR = 2. 638） and no treatment after surgery（ OR = 1. 938） were independent risk factors. Conclusion Limited stage SCLC patients after surgery with raised NSE level before surgery and without treatment after surgery had poor prognosis. In clinical practice, we should combine with the specific circumstances of patients, and give a right and comprehensive treatment.