吉非替尼治疗127例晚期复发非小细胞肺癌患者分类及回归树分析  

Classification and Regression Tree Analysis of Clinical Patterns that Predict Survival in 127 Chinese Patients with Advanced Non-small Cell Lung Cancer Treated by Gefitinib Who Failed to Previous Chemotherapy

作　　者：王子平[1] 郭继红[1] 王燕[1] 刘雨桃[1] 杨娟[2] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院内科,北京100021 [2]四川大学华西公共卫生学院流行病教研室,成都610041

出　　处：《中国肺癌杂志》2011年第9期699-703,共5页Chinese Journal of Lung Cancer

摘　　要：背景与目的二线或三线使用吉非替尼治疗化疗后失败的非选择性晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)的近期疗效只有10%-20%,女性、不吸烟、腺癌及亚裔具有更多的生存优势。然而临床中很难遇到符合以上所有条件的患者,所以有必要在临床中探索一些新的可以预测吉非替尼二、三线治疗晚期NSCLC生存时间的因素以及这些因素之间的相互影响。方法对2005年3月-2010年3月在中国医学科学院肿瘤医院使用吉非替尼治疗的晚期NSCLC的临床资料和生存资料采用分类及回归树(classification and regression tree,CART)分析。结果 127例患者的中位无肿瘤进展生存时间(progression-free survival,PFS)为8个月(95%CI:5.8-10.2)。CART分析将一线化疗疗效及年龄分别作为第一级及次级划分位点,逐级获得3个终末亚组。生存时间最短的是一线化疗进展(progressive disease,PD)的患者,中位PFS仅为1个月(95%CI:0.8-1.2),处于中间位置的为一线化疗中取得部分缓解(partial response,PR)或稳定(stable disease,SD)的患者,年龄<70岁患者的中位PFS为10个月(95%CI:7.0-13.0),而生存时间最长患者的中位PFS为22.0个月(95%CI:3.8-40.1),为一线化疗后PR或SD且年龄≥70岁的患者。结论一线化疗后PR或SD且年龄≥70岁的患者可以获得较长的生存时间,而化疗后进展的患者生存时间不佳。回归树分析可以找出既往被忽略的亚组患者,这对临床工作具有重要的指导意义,并将有利于今后开展相关的临床研究。Background and objective It has been proven that gefitinib produces only 10%-20% tumor regression in heavily pretreated,unselected non-small cell lung cancer （NSCLC） patients as the secondand third-line setting.Asian,female,nonsmokers and adenocarcinoma are favorable factors;however,it is difficult to find a patient satisfying all the above clinical characteristics.The aim of this study is to identify novel predicting factors,and to explore the interactions between clinical variables and their impact on the survival of Chinese patients with advanced NSCLC who were heavily treated with gefitinib in the secondor third-line setting.Methods The clinical and follow-up data of 127 advanced NSCLC patients referred to the Cancer Hospital Institute,Chinese Academy of Medical Sciences from March 2005 to March 2010 were analyzed.Multivariate analysis of progression-free survival （PFS） was performed using recursive partitioning,which is referred to as the classification and regression tree （CART） analysis.Results The median PFS of 127 eligible consecutive advanced NSCLC patients was 8.0 months （95%CI： 5.8-10.2）.CART was performed with an initial split on first-line chemotherapy outcomes and a second split on patients’ age.Three terminal subgroups were formed.The median PFS of the three subsets ranged from 1.0 month （95%CI： 0.8-1.2） for those with progressive disease outcome after the first-line chemotherapy subgroup,10 months （95%CI： 7.0-13.0） in patients with a partial response or stable disease in first-line chemotherapy and age 70,and 22.0 months for patients obtaining a partial response or stable disease in first-line chemotherapy at age 70-81 （95%CI： 3.8-40.1）.Conclusion Partial response,stable disease in first-line chemotherapy and age ≥ 70 are closely correlated with long-term survival treated by gefitinib as a secondor third-line setting in advanced NSCLC.CART can be used to identify previously unappreciated patient subsets and is a useful method for dissecting complex clinical

关 键 词：肺肿瘤 吉非替尼 分类及回归树 

分 类 号：R734.2[医药卫生—肿瘤]