小细胞肺癌患者的临床特点及预后分析

Clinical Features and Prognosis Analysis of Small Cell Lung Cancer

目的分析小细胞肺癌(SCLC)的临床特点及预后影响因素。方法收集明确诊断的SCLC患者260例,给予综合治疗(同步放化疗或化疗±放疗±手术),对比不同治疗方法患者的生存期差异,采用Kaplan Meier法绘制生存曲线,寿命表法计算生存率,SPSS单因素、COX多因素分析预后因素。结果 260例中局限期189例,广泛期71例,全组中位生存期25个月,局限期为29个月,广泛期为13个月,两者生存期差异有统计学意义(P=0.000),全组1年、3年、5年生存率分别为82.3%、21.5%、4.6%,其中局限期患者1年、3年、5年生存率分别为87.1%、28.0%、6.5%,广泛期患者1年、3年、5年生存率分别为70.3%、5.4%、0%。单因素分析示:一线治疗效果、分期、治疗方式、预防性颅脑放疗可影响生存期,伴有少量胸腔积液、锁骨上淋巴结转移患者的预后与局限期患者更相近,伴有上腔静脉综合征的患者预后介于局限期及广泛期患者之间。多因素COX分析示:一线治疗是否有效、分期、治疗方法是影响患者预后的主要因素。结论对于一般情况良好的小细胞肺癌患者,T_(1~2)N_0手术治疗、同步放化疗、提高完全缓解率、复发及进展后进一步治疗,均可提高其生存率,有利于患者长期生存。

Objective To investigate the clinical features and prognosis of small cell lung cancer （SCLC）. Methods Clinical data of 260 patients underwent multimodality therapy （ chemoradiotherapy or chemotherapy ± radiotherapy ± surgery） were collected. Compare the different treatment methods of survival, analyze the clinical features, and the prognostic factors were analyzed by Kaplan-Meier, SPSS single factor and cox-multivariate analysis. Results 260 patients were enrolled, 189 patients were LD and 71 were ED. The median survival of all patients was 25 months ,29 months for patients with limited disease and 13 months for those with extensive disease（P =0.000）. 1-,3-,5-year survival rates were 87.1% ,28.0% ,6.5% of patients with limited disease and 70.3 % ,5.4 % ,0% of patients with extensive disease alive at 1-, 3-, 5-years. Univariate analysis indicated that the efficacy after first-line therapy, stage, treatment, prophylactic brain radiotherapy, significantly influenced survival in SCLC, accompanied by a small amount of pleural effusion or supraclavicular lymph node, patients have same survival with LD. Accompanied by vena cava syndrome, patients have a survival between LD and ED. By multivariate analysis, the effects of first-line treatment, stage, treatment were independent prognostic factors of survival. Conclusion Early operation, complete rate, concurrent chemoradiotherapy, treatment after relapse or metastasis, are the important prognostic factors for SCLC patients with good physical condition.