局部晚期非小细胞肺癌三维适形放疗长期疗效及预后相关因素

The Long-Term Efficacy and Prognostic Factors of Three-Dimensional Conformal Radiotherapy for Locally Advanced Non-small Cell Lung Cancer

目的 探究三维适形放疗治疗局部晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)的远期效果,总结分析预后的影响因素。方法 选取自2010年5月10日至2013年5月11日来我院进行局部晚期非小细胞肺癌诊治的89例患者,患者均于我院接受三维适形放疗,随后对患者进行长期的随访。统计1年生存率、3年生存率、5年生存率。调查可能影响到预后的年龄、性别、病理、临床分期等资料进行单因素和多因素分析。结果 89例患者中2例治疗依从性差,剔除后的87例患者中,近期疗效:完全缓解32例,部分缓解45例,病灶稳定6例,疾病进展4例,治疗有效率为88.51%(77/87)。剔除治疗依从性差的2例患者和失访的3例患者,随访率为94.38%(84/89),随访的84例患者中,1年生存率、3年生存率和5年生存率分别为63.10(53/84)、30.95%(26/84)、19.05%(16/84)。患者的性别、年龄以及TNM分期与患者的预后无关(P>0.05),胸背痛、病理、近期疗效、患者诊治前的血红蛋白值、卡氏评分及白蛋白值与患者的预后有关(P<0.05)。其中卡氏评分、病理、近期疗效是影响患者预后的独立因素(P<0.05)。结论 三维适形放疗计划对局部晚期非小细胞肺癌具有较好的诊治效果,适于临床推广使用,其预后的影响因素多,临床医师需综合评估患者病情,制定适应患者个体化特点的三维适形放疗方案,延长生存期。

Objective To explore the long-term efficacy of three-dimensional conformal radiotherapy in the treatment for locally advanced non-small cell lung cancer（non-small cell lung cancer, NSCLC）, and to summarize and analyze the factors affecting prognosis.Methods 89 patients with locally advanced NSCLC treated in our hospital from May 10, 2010 to May 11, 2013 were given three-dimensional conformal radiotherapy, and received a long-term follow-up.The statistics of 1-year, 3-year and 5-year survival rate was recorded.Data such as age, gender, pathology, and clinical staging that may affect prognosis were processed with single factor analysis and multifactor analysis respectively.Results 2 cases with poor compliance Excluded, short-term effects of the rest 87 patients were as follows： 32 cases of complete remission, 45 cases of partial remission, 6 cases of disease stabilization and 4 cases of disease progression, with an effective rate of 88.51%（77/87）.2 patients with poor compliance and 3 patients lost to follow-up were excluded from the study, with a follow-up rate of 94.38%（84/89）.1-year, 3-year, and 5-year survival rate of the rest84 patients followed up were respectively 63.10%（53/84）, 30.95%（26/84）, and 19.05%（16/84）.Gender, age and TNM stage were not related with prognosis of patients（P0.05）, while chest and back pain, pathology, short-term curative effect, hemoglobin value, Karnofsky performance status and albumin value before treatment were related with prognosis of patients（P0.05）.Karnofsky performance status, pathology and short-term efficacy were independent factors affecting prognosis of patients（P0.05）.Conclusion Three-dimensional conformal radiotherapy has positive effect on the treatment for locally advanced NSCLC, which is suitable for clinical promotion.As it involves plenty of prognostic factors, clinicians need to make a comprehensive assessment of patients to formulate individualized three-dimensional conformal radiotherapy plan so as to prolong their survival period.