局限期小细胞肺癌手术治疗的预后因素分析

Analysis of the prognostic factors of resected limited stage small cell lung cancer

目的探讨局限期小细胞肺癌(SCLC)手术治疗后预后生存相关的影响因素。方法收集2010年10月1日至2015年12月30日在首都医科大学附属北京胸科医院进行手术治疗的67例局限期SCLC患者的临床资料,采用KaplanMeier法计算5年总生存率及5年无病生存率,Cox比例风险回归模型分析影响预后的独立因素。结果全组患者的中位生存期(OS)为49个月,1、3、5年总生存率分别为88.1%、58.2%、46.3%,1、3、5年无病生存率分别为69.7%、47.8%、41.3%。初始分期Ⅰ期患者的5年总生存率为76.2%,Ⅱ期患者为44.4%,Ⅲ期患者为25.0%。单因素分析显示术前有无化疗、术后N分期及术后化疗周期数为影响OS、无病生存期(DFS)的预后因素;Cox多因素回归分析结果显示,N分期及术前化疗为影响OS和DFS的独立预后因素。结论手术切除可能为局限期SCLC带来一定的生存获益,但N+分期患者术后生存差,术后建议给予足够剂量的化疗(化疗周期数≥4)可提高术后5年生存率。新辅助化疗未带来生存获益,主要由于新辅助化疗人群分期晚且新辅助化疗后纵隔未降期导致生存预后差。

Objective To investigate the prognostic factors related to survival after resection of limited stage small cell lung cancer(SCLC).Methods The clinical data of 67 patients of limited stage SCLC who underwent surgical treatment were collected in Beijing Chest Hospital Affiliated to Capital Medical University from October 1,2010 to December 30,2015.Kaplan-Meier method was used to calculate the 5-year overall survival rate and 5-year disease-free survival rate.Cox regression model was used to analyze the independent factors affecting the prognosis.Results The median overall survival(OS)of the whole group was 49 months.The overall survival rates at 1,3 and 5 years were 88.1%,58.2%and 46.3%,and the disease-free survival rates at 1,3 and 5 years were 69.7%,47.8%and 41.3%.The 5-year overall survival rate of patients with initial stageⅠwas 76.2%,that of patients with stageⅡwas 44.4%,and that of patients with stageⅢwas 25.0%.Univariate analysis showed that preoperative chemotherapy and N+stage were the prognostic factors of OS and disease-free survival(DFS).Multivariate analysis showed that N stage and preoperative chemotherapy were the independent prognostic factors of OS and DFS.Conclusion Surgical operation may give survival benefits for limited SCLC,but the survival of patients with N+stage is poor.It is suggested adequate dose of chemotherapy(the number of chemotherapy cycle≥4)after operation to improve the 5-year survival rate.Neoadjuvant chemotherapy did not bring survival benefits,which mainly due to the late stage,and the mediastinum did not descend after neoadjuvant chemotherapy,resulting in poor prognosis.