肿瘤位置对Ⅲ期非小细胞肺癌预后的影响:基于SEER数据库分析

Impact of tumor location on prognosis in patients with stageⅢnon-small cell lung cancer:a Surveillance,Epidemiology,and End Results(SEER)analysis

目的探讨肿瘤位置对Ⅲ期非小细胞肺癌(NSCLC)预后的影响。方法应用美国国立癌症研究所监测、流行病学和最终结果(SEER)数据库对2010—2016年初诊为Ⅲ期[依据美国癌症联合委员会(AJCC)第7版肺癌TNM分期]NSCLC患者的临床资料进行分析,共纳入29253例患者。纳入研究的临床因素包括患者年龄、性别、种族、病理类型、肿瘤位置(中上叶和下叶、左肺和右肺)、TNM分期;纳入研究的治疗因素包括是否手术、是否接受放疗及是否接受化疗。结果根据肿瘤位置(下叶和中上叶)将患者分为下叶组8411例和中上叶组20842例。随访时间为0~83个月,中位随访时间为12个月。下叶组患者的中位生存时间为16.000个月,2年和5年生存率分别为36.9%和17.6%;中上叶组患者的中位生存时间为17.000个月,2年和5年生存率分别39.5%和19.7%;中上叶组患者的生存情况明显优于下叶组患者,差异有统计学意义(P﹤0.01)。多因素Cox回归分析结果显示,年龄、性别、种族、病理类型、肿瘤位置(中上叶和下叶)、T分期、N分期、手术情况、放疗情况、化疗情况均是Ⅲ期NSCLC患者预后的独立影响因素(P﹤0.01)。竞争风险分析结果表明,下叶组患者的肺癌特异死亡风险明显高于中上叶组患者,差异有统计学意义(P﹤0.01);两组患者的其他原因特异死亡风险比较,差异无统计学意义(P﹥0.05)。亚组分析提示,对于手术治疗组和放化疗组,中上叶NSCLC患者的总生存情况均明显优于下叶NSCLC患者(P﹤0.01)。结论肿瘤位置是Ⅲ期NSCLC患者预后的独立影响因素,下叶起源NSCLC患者的预后劣于中上叶起源NSCLC患者。

Objective To investigate the impact of tumor location on prognosis in patients with stageⅢnon-small cell lung cancer(NSCLC).Method Patients with stageⅢNSCLC[according to American Joint Committee on Cancer(AJCC)7 th]from 2010 to 2016 were identified from the Surveillance,Epidemiology,and End Results(SEER)database.A total of 29253 patients were included in the analysis.Variables in the analysis included age,sex,race,pathological type,tumor location(upper and middle lobe vs lower lobe,left lung vs right lung),TNM stage,surgery,radiotherapy and chemotherapy.Result Patients were divided into two groups according to tumor location(upper and middle lobe vs lower lobe),with 8411 patients in lower lobe group and 20842 patients in upper and middle lobe group.The follow up time for the whole population was 0-83 months,and the median follow up time was 12 months.For the lower lobe group,the median overall survival(OS)was 16.000 months,and the 2-,5-year OS rate were 36.9%and 17.6%.For the upper and middle lobe group,the median OS was 17.000 months,and the 2-,5-year OS rate were 39.5%and 19.7%,respectively.The survival of patients in the upper and middle lobe group was significantly better than that in the lower lobe group(P<0.01).Multivariate Cox regression analysis indicated that age,sex,race,pathological type,tumor location(upper and middle lobe vs lower lobe),T stage,N stage,surgery,radiotherapy,and chemotherapy were independent prognostic factors for stageⅢNSCLC patients(P<0.01).Competing risk analysis confirmed that the risk of lung cancer specific death was significantly higher in the lower lobe group than in the upper and middle lobe group(P<0.01),while there was no difference in the risk of other causes specific death between the two groups(P>0.05).Subgroup analysis indicated that the OS in the upper and middle lobe group was significantly better than that in the lower lobe group both in the surgical treatment group and chemoradiotherapy group(P<0.01).Conclusion Tumor location is an independent prognostic factor for stageⅢNSCLC patients,and the prognosis of patients with lower lobe-origin NSCLC is worse than that in patients with upper and middle lobe-origin NSCLC.