Ⅲ期Ⅳ期非小细胞肺癌预后影响因素分析  

Prognostic factors in patients with stage III and IV non-small cell lung cancer

作　　者：宋丽华[1] 宋现让[2] 刘美芹[2] 张锡芹[1] 郑莉[1] 李秀菊[1] 刘蒲香[1] 

机构地区：[1]山东省肿瘤医院内科,济南250117 [2]山东省肿瘤医院检验科,济南250117

出　　处：《中华肿瘤杂志》2004年第6期345-348,共4页Chinese Journal of Oncology

摘　　要：目的　研究Ⅲ、Ⅳ期非小细胞肺癌 (NSCLC)患者的预后相关因素 ,建立具有临床实用性的预后模型。方法　采用Kaplan Meier和Cox回归方法分析 114例NSCLC患者治疗前血清神经元特异性烯醇化酶 (NSE)、癌胚抗原 (CEA)、Cyfra2 1 1、CA12 5、IL 2、sIL 2R等 6种肿瘤标记物的水平及常规临床因素 ,如年龄、性别、吸烟指数、KPS评分、临床分期等与生存率的关系。结果　单因素分析表明 ,临床分期、KPS评分、性别以及治疗前血清Cyfra2 1 1和CA12 5水平与NSCLC患者生存率有关。多因素分析表明 ,Cyfra2 1 1、临床分期及治疗情况是独立的预后影响因素 ,Cyfra2 1 1>3.5mg/L、临床分期为Ⅳ期、治疗少于 3周期时 ,相对危险性 (RR)分别为 1.6 91,2 .2 2 9和 3.0 35。化疗 3周期及以上的患者 ,Cyfra2 1 1、sIL 2R及临床分期是独立的预后影响因素。建立患者治疗前的预后指数 (PI)模型 :PI =Cyfra2 1 1+sIL 2R +Stage。化疗 3周期及以上者 ,PI=0时 ,中位生存期 18个月 ;PI=1或 2时为 8个月 ,PI =3时为 5个月。结论　治疗前血清Cyfra2 1 1、sIL 2R和临床分期 ,是Ⅲ、Ⅳ期NSCLC患者独立的预后影响因素。采用患者治疗前血清Cyfra2 1 1、sIL 2R及临床分期建立的预后指数模型有实际应用价值。Objective To investigate the prognostic factors in non small cell lung cancer (NSCLC) at stage Ⅲ and Ⅳ and establish a reliable model of clinical prognostic index. Methods Kaplan Meier and Cox regression were used to analyze the relationship between the prognostic factors and survival time in 114 cases of NSCLC. The prognostic factors included clinical pathological features and serum levels of cytokeratin fragment 19 (Cyfra21 1), CEA, neuron specific enolase (NSE), CA125, interleukin 2(IL 2) and soluble interleukin 2 receptors (sIL 2R). Results Kaplan Meier analysis showed that KPS, sex, disease stage, treatment, Cyfra21 1, sIL 2R and CA125 were related to prognosis. Multivariate analysis indicated that Cyfra21 1, stage and treatment were independent prognostic factors. When Cyfra21 1>3.5 mg/L, stage Ⅳ and chemotherapy < 3 cycles, the relative risk ( RR ) was 1.691, 2.229 and 3.035, respectively. In patients given 3 or more cycles of chemotherapy, serum Cyfra21 1, sIL 2R and stage at diagnosis were significantly independent prognostic factors. Three of these prognostic factors were used to establish a prognostic index (PI) model based on a simple algorithm: PI = Cyfra21 1 + sIL 2R + stage. The median survival period of patients with 3 or more cycles of chemotherapy were 18 months if PI=0, 8 months if PI=1 or 2, and 5 months if PI=3. Conclusion The serum Cyfra21 1, sIL 2R and disease stage in unresectable NSCLC were independent prognostic factors. PI calculated on the basis of Cyfra21 1, sIL 2R and stage is recommended to predict the survival period of NSCLC.

关 键 词：Ⅲ期 Ⅳ期 非小细胞肺癌 NSCLC 肿瘤标记物 癌胚抗原 细胞角蛋白19片段 

分 类 号：R734.2[医药卫生—肿瘤]