老年晚期非小细胞肺癌患者治疗方式与预后的相关性分析

Correlation Analysis of Treatment and Prognosis in Elderly Patients with Advanced Non-small Cell Lung Cancer

背景随着老龄化的进程,老年非小细胞肺癌(NSCLC)的发病率及死亡率呈逐渐上升趋势,且大多数老年NSCLC患者确诊时已是晚期。晚期NSCLC患者肿瘤异质性较高,其治疗仍存在很多争议,而不同治疗方式的患者预后有所不同。目的分析老年晚期NSCLC患者治疗方式与预后的相关性。方法回顾性选取2013-12-31至2019-09-30于陕西省人民医院老年呼吸科、肿瘤科、胸外科住院治疗的老年晚期NSCLC患者194例为研究对象。其中接受最佳支持治疗(BSC)的患者有32例(16.5%),接受积极抗肿瘤治疗的患者有162例(83.5%)(其中一线化疗55例、手术联合化疗40例、化疗联合放疗40例、其他治疗27例)。收集患者的一般资料及随访资料,计算患者的总生存期(OS)和中位生存时间(MST),统计随访截止时患者的生存情况。比较BSC患者和积极抗肿瘤治疗患者一般资料、生存率。比较一线化疗、手术联合化疗、化疗联合放疗患者一般资料、生存率。分析老年晚期NSCLC患者预后的影响因素。分析一线化疗、手术联合化疗、化疗联合放疗患者毒副作用发生情况。结果所有患者的OS为18.4〔95%CI(15.7,21.1)〕个月,MST为12.1〔95%CI(11.3,12.9)〕个月。随访截止时生存41例、死亡153例。BSC患者和积极抗肿瘤治疗患者性别、年龄、体力活动状态(PS)评分、TNM分期、远处转移情况比较,差异有统计学意义(P<0.05)。BSC患者累积生存率低于积极抗肿瘤治疗患者(P<0.05)。一线化疗、手术联合化疗、化疗联合放疗患者吸烟史比较,差异有统计学意义(P<0.05)。一线化疗、化疗联合放疗患者累积生存率低于手术联合化疗患者(P<0.05);一线化疗患者和化疗联合放疗患者累积生存率比较,差异无统计学意义(P>0.05)。多因素Cox回归分析结果显示,年龄〔HR=1.603,95%CI(1.085,2.368)〕、合并症〔HR=2.346,95%CI(1.440,3.820)〕、PS评分〔HR=2.220,95%CI(1.336,3.688)〕、TNM分期〔HR=2.526,95%CI(1.502,4.250)〕、远处转移〔HR=2.424,95%CI(1.464,3.959)〕、一线化疗〔HR=0.573,95%CI(0.363,0.905)〕、手术联合化疗〔HR=0.207,95%CI(0.110,0.338)〕是老年晚期NSCLC患者预后的影响因素(P<0.05)。一线化疗患者中,发生血液系统毒副作用18例、消化系统毒副作用14例;手术联合化疗患者中,发生血液系统毒副作用11例、消化系统毒副作用10例;化疗联合放疗患者中,发生血液系统毒副作用20例、消化系统毒副作用10例。结论积极抗肿瘤治疗较BSC能明显提高老年晚期NSCLC患者生存率、延长生存期,且一线化疗、手术联合化疗是老年晚期NSCLC患者预后的保护因素。此外,在接受多种抗肿瘤治疗时需警惕血液、消化系统毒副作用的发生。

Background With the progress of aging,the morbidity and mortality of elderly non-small cell lung cancer(NSCLC)are gradually increasing,and most elderly NSCLC patients are already at the advanced stage when they are diagnosed.The heterogeneity of advanced NSCLC is high,there are still many controversies about its treatment,and different treatment methods have different prognosis.Objective To analyze the correlation between treatment and prognosis in elderly patients with advanced NSCLC.Methods A total of 194 elderly patients with advanced NSCLC who were hospitalized in the Department of Geriatric Respiratory Surgery,Department of Oncology and Department of Thoracic Surgery of Shaanxi Provincial People's Hospital from December 31,2013 to September 30,2019 were retrospectively selected as the research objects.Among them,32 patients(16.5%)received the best supportive care(BSC),and 162 patients(83.5%)received active anti-tumor therapy(55 with first-line chemotherapy,40 with surgery combined with chemotherapy,40 with chemotherapy combined with radiotherapy,and 27 with other treatments).The general data and follow-up data of the patients were collected,the overall survival(OS)and median survival time(MST)of all patients were calculated,and their survival at the end of follow-up were analyzed.The general data and survival rate of patients with BSC were compared with those with active anti-tumor therapy.The general data and survival rate of patients with first-line chemotherapy,surgery combined with chemotherapy and chemotherapy combined with radiotherapy were compared.The prognostic factors of elderly patients with advanced NSCLC were analyzed.For patients with first-line chemotherapy,surgery combined with chemotherapy,and chemotherapy combined with radiotherapy,their toxic and side effects were analyzed.Results The OS and MST of all patients were 18.4[95%CI(15.7,21.1)]months and 12.1[95%CI(11.3,12.9)]months.At the end of follow-up,41 cases survived and 153 cases died.There were statistically significant differences in gender,age,performance status(PS)score,TNM stage and distant metastasis between BSC patients and active anti-tumor therapy patients(P<0.05).The cumulative survival rate of patients with BSC was lower than that of patients with active anti-tumor therapy(P<0.05).There was statistically significant difference in smoking history among patients with first-line chemotherapy,surgery combined with chemotherapy,and chemotherapy combined with radiotherapy(P<0.05).The cumulative survival rate of patients with first-line chemotherapy and chemotherapy combined with radiotherapy was lower than that of patients with surgery combined with chemotherapy(P<0.05).There was no significant difference in cumulative survival rate between first-line chemotherapy patients and chemotherapy combined with radiotherapy patients(P>0.05).Multivariate Cox regression analysis results showed that age[HR=1.603,95%CI(1.085,2.368)],complications[HR=2.346,95%CI(1.440,3.820)],PS score[HR=2.220,95%CI(1.336,3.688)],TNM stage[HR=2.526,95%CI(1.502,4.250)],distant metastasis[HR=2.424,95%CI(1.464,3.959)],firstline chemotherapy[HR=0.573,95%CI(0.363,0.905)],surgery combined with chemotherapy[HR=0.207,95%CI(0.110,0.338)]were influencing factors for the prognosis of elderly patients with advanced NSCLC(P<0.05).Among the first-line chemotherapy patients,there were 18 cases of toxic and side effects of blood system and 14 cases of toxic and side effects of digestive system.Among the patients undergoing surgery combined with chemotherapy,11 cases had toxic and side effects of blood system and 10 cases had toxic and side effects of digestive system.Among the patients with chemotherapy combined with radiotherapy,there were 20 cases of toxic and side effects of blood system and 10 cases of toxic and side effects of digestive system.Conclusion Compared with BSC,active anti-tumor therapy can significantly improve the survival rate and lengthen survival time of elderly patients with advanced NSCLC,and first-line chemotherapy and surgery combined with chemotherapy are protective factors for the prognosis of elderly patients with advanced NSCLC.In addition,it is necessary to be alert to the occurrence of toxic and side effects of blood and digestive system when receiving a variety of anti-tumor therapies.