^125I粒子联合化疗治疗局限期小细胞肺癌预后及影响因素分析

Analysis of prognosis and influencing factors of CT-guided ^125I radioactive seed implantation combined with chemotherapy for limited-stage small cell lung cancer

目的 评估CT引导下125I放射性粒子植入联合全身化疗治疗局限期小细胞肺癌（limited-stage small cell lung cancer LS-SCLC）的临床疗效及影响预后因素。方法 2008年6月至2012年6月在天津医科大学第二医院接受125I粒子植入联合全身化疗治疗的LS-SCLC患者128例。采用χ2检验对患者近期疗效影响因素进行分析。采用Kaplan-Meier法计算生存率，Log-rank进行单因素分析，采用Cox比例风险模型进行多因素分析。结果 全组128例患者治疗后，6个月总有效率86.7%（111/128）。1、2、3年生存率分别为77.9%、39.8%、28.0%；中位生存期21.0个月。单因素分析结果显示，年龄、一般状态（performance status，PS）、术前血红蛋白、吸烟指数、肿瘤直径、术前神经元特异性烯醇化酶（neuron-specific enolase，NSE）、是否接受预防性全脑照射（prophylactic cranial irradiation，PCI）、化疗周期数、化疗疗效、处方剂量、术后D100、治疗模式均可影响LS-SCLC患者的生存。多因素分析结果显示，年龄、PS评分、术前血红蛋白、肿瘤直径、处理方剂量、化疗周期数、化疗疗效及治疗模式是LS-SCLC的独立预后因素。全组术中气胸29例占22.7%，咯血16例，占12.5%。结论 125I放射性粒子植入治疗LS-SCLC显示了较好的疗效，年龄、PS评分、术前血红蛋白、肿瘤直径、PD、化疗周期数、化疗疗效及治疗模式为LS-SCLC患者预后的主要影响因素。

Objective To evaluate the clinical efficacy and prognostic factors of limited-stage small cell lung cancer （LS-SCLC）treated with 125I radioactive seed implantation guided by CT combined with systemic chemotherapy. Methods A total of 128 limited-stage small cell lung cancer patients were treated with 125I radioactive seed implantation combined with chemotherapy from Jun 2008 to Jun 2012 in Tianjin Medical University Second Hospital.The χ2 test was used to analyze the influencing factors of short-term efficacy. Survival rate was calculated by Kaplan-Meier method, single factor analysis was performed by Log-rank, and multivariate analysis was performed by Cox proportional hazard model. Results Totally 128 patients finished the treatment. The overall response rate was 86.7% （111/128） after 6 months of treatment. The 1-, 2-and 3-year overall survival rate was 77.9%, 39.8%and 28.0%, respectively, and the median survival time was 21.0 months. The univariate analysis showed that the following factors were main prognostic factors：age, performance status （PS）, hemoglobin ≥ 120 g/L before treatment, smoking index, the maximum diameter of tumor, neuron-specific enolase before treatment, subscribe for prophylactic cranial irradiation （PCI）, number of chemotherapy cycle, chemotherapy response, prescribed dose （PD）, postoperation dose covering 100% volume （D100）, remedial model. multivariate analysis revealed that age, PS, hemoglobin ≥ 120 g/L before treatment and PD, the maximum diameter of tumor, number of chemotherapy cycle, chemotherapy response, and remedial model were the independent prognostic factors for survival. 29 patients of 128 suffered from aerothorax and the incidence rate of aerothorax was 27.7%. Totally 16 patients occurred hemoptysis and theincidence rate was 12.5%. Conclusions 125I radioactive seed implantation therapy showed good effecacy in the treatment of LS-SCLC. Age, PS, hemoglobin ≥ 120 g/L before treatment, the maximum diameter of tumor, number of chemotherapy cycle, chemotherapy response, and remedial model might be the main prognostic factors for LS-SCLC patients.