非小细胞肺癌根治术后辅助化疗的预后因素分析

Analysis of prognostic factors of non-small cell lung cancer after radical resection and postoperative adjuvant chemotherapy

目的探讨非小细胞肺癌(NSCLC)根治术后辅助化疗的预后因素。方法回顾性分析徐州医科大学附属医院2014年1月—2018年12月收治的201例接受肺癌根治术、病理确诊为NSCLC、接受术后辅助化疗患者的临床资料,主要包括患者基本信息、手术及肿瘤相关信息、血液学指标、术后治疗相关信息等。主要研究指标为无病生存期,采用Kaplan-Meier法进行生存分析,Cox回归模型进行单因素及多因素分析。结果201例患者中位随访时间为38个月。单因素分析结果显示,年龄、吸烟、TNM分期、CEA水平、手术与第1次化疗间隔时间、术后化疗周期数是影响NSCLC根治术后辅助化疗预后的危险因素(P<0.05);多因素分析结果显示,年龄≥65岁、TNM分期Ⅲ期是影响NSCLC根治术后辅助化疗预后的独立危险因素;术后50天内开始化疗、化疗周期数>4是预后的保护因素。结论年龄≥65岁、TNM分期较晚的NSCLC患者无病生存期可能更短,应提高随访频率。同时,在一般状况允许的情况下,建议术后50天内开始行4周期以上辅助化疗。

Objective To investigate the prognostic factors of non-small cell lung cancer(NSCLC)after radical resection and postoperative adjuvant chemotherapy.Methods Retrospective analysis was made on the clinical data of 201 patients in the Affiliated Hospital of Xuzhou Medical University who received radical resection and postoperative adjuvant chemotherapy and pathologically confirmed as NSCLC between January 2014 and December 2018,mainly including the basic information of patients,surgery and tumor relevant information,hematological indicators,postoperative treatment and so on.The primary endpoint of the study was disease-free survival.Survival analysis,single and multi-factor analysis were separately performed by Kaplan-Meier method and Cox regression model.Results The median follow-up time of 201 patients was 38 months.Univariate analysis results showed that the risk factors included age,smoking,TNM stage,CEA level,interval between surgery and the first chemotherapy and postoperative chemotherapy cycles for the prognoses of NSCLC patients after radical resection and postoperative adjuvant chemotherapy(P<0.05).The results of multivariate analysis showed that patients≥65 years and TNM stageⅢwere independent risk factors affecting the prognoses of NSCLC patients after radical resection and postoperative adjuvant chemotherapy.Initiation of chemotherapy within 50 days after surgery and more than 4 cycles chemotherapy were protective factors for the prognoses of these patients.Conclusion NSCLC patients with age≥65years and advanced TNM stage may have a shorter disease-free survival,so their follow-up frequency should be increased.At the same time,if the general condition allows,it is recommended to start more than 4 cycles of adjuvant chemotherapy within 50 days after surgery.