心血管疾病风险对非小细胞肺癌患者的预后影响

Effect of cardiovascular disease risk on prognosis in patients with non-small cell lung cancer

目的探讨心血管危险因素对非小细胞肺癌(NSCLC)患者预后生存的影响。方法回顾性选取2012年3月至2017年3月间中国医学科学院肿瘤医院收治的经细胞学或病理确诊为NSCLC的389例患者的临床资料,分析患者年龄、性别、Karnofsky(KPS)评分、临床分期、治疗方式、EGFR基因突变、转移灶数目、心血管毒性危险评分(CRS)等因素,采用Kaplan-Meier生存分析法进行单因素分析,用Cox回归模型进行多因素预后分析。结果低危组患者247例(63.5%),高危组患者142例(36.5%)。两组患者年龄、性别和是否吸烟比较,差异均有统计学意义(均P<0.05);两组患者KPS评分、EGFR基因突变、临床分期、转移灶数目和治疗方式等比较,差异无统计学意义(P>0.05)。低危组患者中位生存时间37.0个月,高危组为29.0个月。女性NSCLC低危组患者、年龄<65岁低危组患者、KPS>80分低危组患者、临床Ⅲ期NSCLC低危组患者、无吸烟史低危组患者、接受手术联合化疗低危组患者和未接受手术联合化放疗治疗低危组患者的生存时间均较高危组长,差异均有统计学意义(均P<0.05)。CRS分组、KPS评分和临床分期均是影响NSCLC患者预后的因素,差异均有统计学意义(均P<0.05)。结论心血管疾病危险因素是影响NSCLC患者预后的因素之一,抗肿瘤治疗时应重视心血管疾病风险的防控,CRS评分模型可能对临床监测、评估和管理NSCLC患者的心血管疾病风险有指导意义。

Objective To investigate the effect of cardiovascular risk factors on prognosis and survival in patients with non-small cell lung cancer(NSCLC).Methods A retrospective analysis of medical records of 389 patients who were diagnosed with NSCLC by cytology and pathology tests at Chinese Academy of Medical Sciences from March 2012 to March 2017 were performed.Factors including age,gender,Karnofsky performance score(KPS),clinical staging,treatment,EGFR gene mutation,number of metastases and cardiovascular toxicity risk score(CRS)were analyzed.Kaplan-Meier survival analysis was used for univariate analysis,and Cox regression model was used for prognostic analysis.Results There were 247 patients(63.5%)in the low risk group and there were 142 patients(36.5%).There were significant differences in age,gender and history of smoking(all P<0.05).There was no significant difference in KPS score,EGFR gene mutation,clinical staging,number of metastases and therapy regimen between the two groups(P>0.05).The median survival was 37.0 months in the low-risk group and 29.0 months in the high-risk group(P<0.05).Low-risk patients of female,under 65 years,KPS>80,stageⅢ,no smoking history,undergoing or not undergoing surgery complicated with chemotherapy had longer survival(all P<0.05).CRS classification,KPS and clinical stage had an impact on the survival and prognosis in patients with NSCLC(all P<0.05).Conclusion Cardiovascular disease risk factors are one of the factors affecting the prognosis of NSCLC patients.Anti-tumor therapy should also pay attention to the prevention and control of cardiovascular disease risk.CRS scoring model may be of guiding significance for clinical monitoring,assessment and management of cardiovascular disease risk in NSCLC patients.