小细胞肺癌长期生存患者的临床病理特征及预后分析

Clinicopathological features and prognosis of patients with long-term survival of small cell lung cancer

目的:分析小细胞肺癌长期生存患者的临床、病理特征,探讨长期生存的预后影响因素。方法:收集2013年1月至2017年1月在福建医科大学附属泉州第一医院确诊并治疗的124例小细胞肺癌患者,按总生存时间(overall survival,OS)分为长期生存组(>24个月)和短期生存组,分析比较2组的临床病理特征,并对长期生存的影响因素进行Kaplan-Meier法生存分析和Cox比例风险模型多因素分析。结果:124例小细胞肺癌患者,24例(19.4%)OS>24个月。长期生存组的局限期、无肝转移患者比例高于短期生存组(P<0.05),而性别、年龄、身高、体质量、脑转移、其他部位转移、血清乳酸脱氢酶(lactate dehydrogenase,LDH)2组间差异无统计学意义(P>0.05);长期生存组的TTF-1阳性、Ki67低表达比例患者高于短期生存组(P<0.05);长期生存组患者对初始化疗更为敏感(P<0.05)。生存分析显示,局限期、无肝转移、TTF-1阳性表达、Ki67低表达、对初始化疗敏感的患者中位OS较高(P<0.05);多因素分析显示,TTF-1阳性、Ki67低表达及无肝转移是预后较好的独立因素(P<0.05)。结论:临床分期、肝转移、TTF-1、Ki67及初始化疗敏感性是预测小细胞肺癌患者长期生存的重要指标,肝转移、TTF-1及Ki67是其独立预后因素。

Objective:To analyze the clinicopathological features of patients with long-term survival of small cell lung cancer,and to explore the prognostic factors for long-term survival.Methods:A total of 124 patients with small cell lung cancer diagnosed and treated in our hospital from January 2013 to January 2017 were enrolled.Patients were divided into long-term survival group(>24 months)and short-term survival group according to overall survival(OS).Clinicopathological features of the two groups were compared.Kaplan-Meier survival analysis and multivariate analysis using the Cox proportional hazards model were performed to identify long-term survival factors.Results:Of the 124 patients with small cell lung cancer,24(19.4%)had an OS time longer than 24 months.The long-term survival group had a higher proportion of patients in limited stage and with no liver metastasis than the short-term survival group(P<0.05),while there were no significant differences in sex,age,height,weight,brain metastasis,other metastases,and serum lactate dehydrogenase(LDH)between the two groups(P<0.05).The long-term survival group had a significantly higher proportion of patients with positive TTF-1 and low Ki67 expression than the short-term survival group(P<0.05).Cases in the long-term survival group were more sensitive to initial chemotherapy(P<0.05).Survival analysis showed that median OS was relatively high in patients in limited stage,with no liver metastasis,positive expression of TTF-1,low expression of Ki67,and sensitivity to initial chemotherapy(P<0.05).Multivariate analyses showed positive TTF-1,low Ki67 expression,and no liver metastasis were independent indicators of better prognosis(P<0.05).Conclusion:Clinical stage,liver metastasis,TTF-1 expression,Ki67 expression,and initial chemotherapy sensitivity are important factors for long-term survival in patients with small cell lung cancer.Liver metastasis,TTF-1,and Ki67 are independent prognostic factors.