治疗后生存状态变化对Ⅳ期非小细胞肺癌化疗同期三维放射治疗生存的影响  

The impact of Karnofsky performance status of posttreatment on survival with concurrent chemotherapy and thoracic three-dimensional radiotherapy for stageⅣnon-small cell lung cancer

作　　者：杨牧野 欧阳伟炜 苏胜发 马筑 李青松 耿一超 王羽 罗大先 杨文刚 胡银祥 栗蕙芹 何志旭[3] 卢冰 Yang Muye;Ouyang Weiwei;Su Shengfa;Ma Zhu;Li Qingsong;Geng Yichao;Wang Yu;Luo Daxian;Yang Wengang;Hu Yinxiang;Li Huiqin;He Zhixu;Lu Bing(Teaching and Research Section of Oncology,Guizhou Medical University,Guiyang 550004, China;Affiliated Hospital of Guizhou Medical University,Department of Oneology,Guizhou Cancer Hospital,Guiyang 550004,China;Stem Cell and Tissue Engineering Research Center,Guizhou Medical University,Guiyang 550001,China)

机构地区：[1]贵州医科大学肿瘤学教研室,贵阳550004 [2]贵州医科大学附属医院贵州省肿瘤医院肿瘤科,贵阳550004 [3]贵州医科大学组织工程及干细胞实验中心,贵阳550001

出　　处：《中华放射医学与防护杂志》2019年第1期51-57,共7页Chinese Journal of Radiological Medicine and Protection

基　　金：贵州省教育厅创新群体重大研究项目(黔教合KY字[2016]032);贵州省应用基础研究计划重大专项(黔教合J重大字[2015]2003).

摘　　要：目的探讨Ⅳ期非小细胞肺癌(NSCLC)同期放化疗后生存状态(karnofsky performance status of posttreatment,KPSpost)变化对生存的影响及其相关因素。方法322例中纳入分析279例,病理学确诊的初治Ⅳ期NSCLC,其中男性198例、女性81例;鳞癌166例、腺癌87例、未分型22例;中位年龄58岁(22~80岁);完成化疗≥2个周期同期原发肿瘤剂量≥36Gy治疗。Kaplan-Meier法并Log-rank检验和Cox回归模型进行总生存(OS)的单因素和多因素分析,χ^2检验及Logistic回归分析探讨KPSpost的相关因素。结果KPSpost改善198例、降低81例。单因素及多因素分析均显示KPSpost改善,生存期延长。χ^2检验和logistic回归多因素分析均显示KPSpost改善与完成化疗4~6个周期同期原发肿瘤剂量≥63Gy、获得近期疗效呈正相关,与血小板不良反应、放射性食管炎分级呈负相关。结论Ⅳ期非小细胞肺癌同期放化疗KPSpost是OS的独立影响因子。化疗4~6个周期同期原发肿瘤剂量≥63Gy、近期疗效获益有利于KPSpost改善,3~4级的血小板不良反应和放射性食管炎显著降低KPSpost。Objective To investigate the impact of the changes of posttreatment karnofsky performance status(KPSpost)on the overall survival(OS)for patients with stageⅣnon-small cell lung cancer(NSCLC)underwent concurrent chemoradiation.Methods A total of 279 patients(male 198 and female 81)with histological confirmed stageⅣNSCLC were enrolled in this study with a median age of 58 years old(range 22 to 80 years old).There were 166 cases of squamous carcinoma,87 cases of adenocarcinoma,and 22 cases of unclassified carcinoma,respectively.All enrolled patients received more than 2 cycles of chemotherapy and more than 36 Gy of concurrent radiotherapy.Kaplan-Meier method and Log-rank test were applied to evaluate OS.Multivariate analyses were carried out by the Cox proportional-hazard model.Chi-square test and logistic regression analysis were used to explore the related factors of KPSpost.Results There were 198 patients with improved KPSpost and 81 patients with decreased KPSpost,respectively.Univariate and multivariate analyses indicated that the improvement of KPSpost was associated with longer OS.Logistic regression analysis showed that the improvement of KPSpost was positively related with treatment of more than 4-6 cycles chemotherapy concurrent with over 63 Gy radiation to primary tumor.The improvement of KPSpost also correlated positively with disease control rate(DCR),but negatively with PLT toxicity and radiation esophagitis.Conclusions KPSpost was an independent prognostic factor of OS for patients with stageⅣNSCLC underwent concurrent chemoradiation.Chemotherapy of 4-6 cycles and concurrent over 63 Gy radiotherapy dose to primary tumor,as well as DCR were positive factors for KPSpost improvement.However,stage 3-4 PLT toxicities and radiation esophagitis decreased the KPSpost.

关 键 词：非小细胞肺癌 同期放化疗 治疗后生存状态 总生存 

分 类 号：R734.2[医药卫生—肿瘤]