晚期非小细胞肺癌长期生存患者临床特征及治疗相关因素分析  

Clinical features and related factors for treatment of non-small cell lung cancer patients with long-term survival

作　　者：秦舣 黄媚娟[1] 李艳莹[1] 余敏[1] 刘兰 任莉[1] 王永生[1] 宫友陵[1] 彭枫[1] 朱江[1] 丁振宇[1] 刘咏梅[1] 徐泳[1] 王瑾[1] 周晓娟[1] 卢铀[1] QIN Yi;HUANG Meijuan;LI Yanying;YU Min;LIU Lan;REN Li;WANG Yongsheng;GONG Youling;PENG Feng;ZHU Jiang;DING Zhenyu;LIU Yongmei;XU Yong;WANG Jin;ZHOU Xiaojuan;LU You(Department of Thoracic Oncology,Cancer Center,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China)

机构地区：[1]四川大学华西医院肿瘤中心胸部肿瘤科,成都610041

出　　处：《华西医学》2019年第1期12-17,共6页West China Medical Journal

基　　金：四川省科技厅基金(2018SZ0023);吴阶平医学基金会项目(320.6750.18128)

摘　　要：目的探讨晚期非小细胞肺癌长期生存患者的临床特征及治疗相关因素。方法对四川大学华西医院胸部肿瘤科2010年1月—2015年12月收治的经病理学确诊且可供分析的963例Ⅳ期非小细胞肺癌患者的临床特征、治疗因素及生存情况进行回顾性分析。结果生存分析结果显示,963例患者中位生存期为20.8个月,1、3、5、7年生存率分别为72.0%、21.4%、15.2%、4.8%。长期生存者(生存期>60个月)81例,非长期生存者(生存期<60个月)882例。既往手术、胸部放射治疗(放疗)以及表皮生长因子受体(epidermal growth factor receptor,EGFR)基因阳性显著影响5年实际存活率,分别降低死亡风险62.0%、58.8%、58.1%。与非长期生存组相比,长期生存组内更多患者接受了包括手术、胸部放疗及靶向治疗在内的2种或2种以上手段(28.4%vs. 11.6%,P<0.001),长期生存组有更多患者在四线及以上的后线治疗中获益(24.7%vs. 11.1%,P<0.001)。Cox多因素分析显示功能状态评分[风险比(hazard ratio,HR)=1.388,95%置信区间(confidence interval,CI)(1.199,1.608),P<0.001]、N分期[HR=1.160,95%CI(1.058,1.272),P=0.002]、EGFR基因突变[HR=0.588,95%CI(0.469,0.738),P<0.001]、既往手术[HR=0.626,95%CI(0.471,0.832),P=0.001]、胸部放疗[HR=0.592,95%CI(0.480,0.730),P<0.001]是总生存期的独立影响因素(P<0.05)。结论功能状态评分、N分期、EGFR基因突变、既往手术及胸部放疗是影响晚期非小细胞肺癌患者生存的重要预后因素。多种治疗手段的综合治疗及后线治疗的持续获益有利于长期生存。Objective To investigate the clinical features of non-small cell lung cancer(NSCLC) patients with long-term survival and the related factors for treatment. Methods A retrospective analysis of clinical features, treatment factors, and survival was performed for 963 patients with pathologically confirmed stage Ⅳ NSCLC between January 2010 and December 2015 from Department of Thoracic Oncology, West China Hospital, Sichuan University. Results The median overall survival(OS) of the 963 patients was 20.8 months, and the 1-, 3-, 5-, and 7-year survival rates were 72.0%,21.4%, 15.2%, and 4.8%, respectively. There were 81 patients in the long-term survival group(OS>60 months) and 882 in the non-long-term survival group(OS<60 months). Previous surgery, thoracic radiotherapy and epidermal growth factor receptor(EGFR) gene positive significantly increased the 5-year actual survival rate, reducing the risk of death by 62.0%,58.8%, and 58.1%, respectively. Compared with the non-long-term survival group, more patients in the long-term survival group received two or more means of treatment including surgery, thoracic radiotherapy, and targeted therapy(28.4% vs.11.6%, P<0.001) and more patients benefited from fourth-or further-line treatment(24.7% vs. 11.1%, P<0.001). Cox multivariate regression analysis indicated that performance status [hazard ratio(HR)=1.388, 95% confidence interval(CI)(1.199, 1.608), P<0.001], N stage [HR=1.160, 95%CI(1.058, 1.272), P=0.002], EGFR gene status [HR=0.588, 95%CI(0.469, 0.738), P<0.001], previous surgery [HR=0.626, 95%CI(0.471, 0.832), P=0.001], and thoracic radiotherapy[HR=0.592, 95%CI(0.480, 0.730), P<0.001] were independent prognostic factors of OS. Conclusions Good performance status, early N staging, EGFR mutation, previous surgery, and thoracic radiotherapy are important prognostic factors affecting the survival of advanced NSCLC patients. Long-term survival benefits from combined treatment and effective further-line therapies.

关 键 词：长期生存 5年生存率 非小细胞肺癌 Ⅳ期 预后因素 

分 类 号：R734.2[医药卫生—肿瘤]