610例Ⅲ、Ⅳ期非小细胞肺癌患者预后生存分析  

Prognostic surrival in 610 patients with stages Ⅲ and Ⅳ non-small cell lung cancer

作　　者：高月霞[1] 黄彬鋆[2] 吴桂云[2] 沈飚[3] 沈康[3] 肖静[2] 

机构地区：[1]南通大学公共卫生学院卫生管理教研室,江苏南通226019 [2]南通大学公共卫生学院统计学教研室,江苏南通226019 [3]南通市肿瘤医院胸外科,江苏南通226361

出　　处：《中华疾病控制杂志》2015年第1期74-77,共4页Chinese Journal of Disease Control & Prevention

基　　金：国家自然科学青年基金(31000539);南通市科技局资助项目(s10921)

摘　　要：目的 探讨Ⅲ、Ⅳ期非小细胞肺癌（non-small cell lung cancer,NSCLC）预后的影响因素。方法 回顾性分析2005年1月~2010年12月610例NSCLC患者的临床资料,使用Kaplan-Meier法计算生存率,单因素分析用Log-rank检验,多因素分析用Cox比例风险模型。结果 全部病例中位生存时间为12个月,6、12、24和36个月的生存率分别为69.2%、49.5%、27.0%和20.0%。单因素分析中,性别、TNM分期、治疗方案和吸烟史与预后有关（均有P〈0.05）。多因素回归分析,在控制其他变量的情况下,男性的相对死亡风险比（RR）是女性的1.380倍（P=0.002）;以IV期患者为对照,ⅢA、ⅢB期的患者RR值分别为0.464（P〈0.001）、0.846（P=0.145）;以对症治疗为对照,手术、化疗、放疗、放化结合、综合治疗的RR值分别为0.951、0.632、0.918、0.572和0.537。以性别作为分层因素进行回归分析,TNM分期、治疗方案及吸烟史与男性的预后有关,女性仅TNM分期影响预后。结论 性别、TNM分期以及治疗方案是影响Ⅲ、Ⅳ期非小细胞肺癌患者预后的独立因素。吸烟史是影响男性NSCLC患者预后的独立因素。Ⅲ、Ⅳ期NSCLC患者首选综合治疗。Objective To investigate the prognostic factors in patients with stage III and IV non-small cell lung cancer （NSCLC）. Methods The clinical data of 610 patients with NSCLC were investigated by the retrospective analysis between January 2005 and December 2010. The survival rate was calculated by the Kaplan-Meier method. The Log-rank test and Cox proportional hazards regression model were used to analyze the relationships between the prognostic factors and survival time. Results The overall median survival time was 12 months, and the 6-, 12- , 24- and 36 - month sur- vival rate were 69.2% , 49.5% , 27.0% and 20.0% , respectively. The Log-rank test showed that gender, TNM stage, therapeutic regimes and smoking history were associated with survival （ all P 〈 0. 01 ）. Multivariate regression analysis suggested that controlled for the other factors, the males had higher risk for shorter survival than the females （ the relative risk ratio, RR = 1. 380）. Patients with stage IlIA and IlIB had longer survival than patients with stage IV（RR =0. 464, RR = 0. 846 ）. Taken symptomatic therapy as a control, patients with surgical therapy, chemotherapy, radiotherapy, combination of chemotherapy and radiotherapy, and comprehensive therapy were more likely to have better survival（ RR = 0. 951, RR = 0. 632, RR =0. 918, RR =0. 572, RR =0. 537）. Setting gender as a stratification factor in the regression analysis, TNM stage, treatment and smoking history were associated with the prognosis of male patients. Only TNM stage affected the prog- nosis of female patients. Conclusions Gender, TNM stage and treatment regimes are independent prognostic factors in patients with stage III and IV NSCLC. Smoking history is an independent prognostic factor in male patients. The comprehensive therapy should be the preferred choice for patients with stage III and IV NSCLC.

关 键 词：癌 非小细胞肺 化学疗法 辅助 回归分析 

分 类 号：R195.1[医药卫生—卫生统计学] R734.2[医药卫生—卫生事业管理]