214例肺腺癌患者预后因素分析  

Prognostic factors analysis in 214 patients with lung adenocarcinoma

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

机构地区：[1]南通大学公共卫生学院卫生统计学教研室,江苏南通226019 [2]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8期806-810,共5页Chinese Journal of Disease Control & Prevention

基　　金：国家青年科学基金(31000539);江苏省六大人才高峰资助(2013-WSW-008);南通市科技局资助(10921)

摘　　要：目的 了解Ⅲ期、Ⅳ期肺腺癌患者的生存现状及预后影响因素。方法 回顾性分析2005年1月1日-2010年12月31日南通市肿瘤医院214例肺腺癌患者的临床资料,使用Kaplan-Meier法计算生存率,单因素分析和多因素分析分别用Log-rank检验与Cox回归模型。结果 全组病例中位生存时间为12个月,12、24、36月的生存率分别为50.0%、28.0%、19.9%。单因素分析表明,性别、TNM（tumor node metastasis）分期、血清细胞角蛋白19片段（CYFRA21-1）、治疗方案、吸烟史与预后有关（均有P〈0.05）。Cox多因素回归分析表明：以Ⅳ期为对照组,ⅢA、ⅢB期的患者相对死亡风险降低了62.4%（RR=0.38,P〈0.001）、27.8%（RR=0.72,P=0.083）;CY-FRA21-1阳性组的相对死亡风险比阴性组增加了38.9%（RR=1.39,P=0.044）;以对症治疗为对照,手术、化疗、放疗、放化结合、综合治疗的相对死亡风险分别降低了34.1%（RR=0.66,P=0.378）、64.9%（RR=0.35,P〈0.001）、30.0%（RR=0.70,P=0.298）、60.3%（RR=0.40,P=0.001）、75.2%（RR=0.25,P=0.002）;有吸烟史的相对死亡风险比无吸烟史增加了64.5%（RR=1.65,P=0.011）。结论 TNM分期、CYFRA21-1、治疗方案、吸烟史是Ⅲ期Ⅳ期肺腺癌患者预后的影响因素。Objective To investigate the survival status and prognostic factors in patients with stage Ⅲ and Ⅳlung adenocarcinoma. Methods Clinical data of 214 lung adenocarcinoma patients from Nantong Tumor Hospital were investigated by retrospective analysis between January 1st,2005 and December 31 th,2010. The survival rate was calculated by the Kaplan-Meier method,log-rank test and Cox regression model were used to analyze the relationship between prognostic factors and survival duration. Results The overall median survival duration was 12 months. 12-,24-,36- month survival rates were 50. 0%,28. 0%,and 19. 9%,respectively. The long-rank test showed gender,stage（ tumor node metastasis,TNM）,levels of serum cytokeratin 19 fragment（ CYFRA21-1）,therapeutic strategy and smoking history were associated with survival. Cox multivariate regression analysis showed that,patients with stage IV as the control group,the relative risks（ RR） of death of patients with stage ⅢA and ⅢB decreased by 62. 4%（ RR = 0. 38,P〈0. 001） and 27. 8%（ RR= 0. 72,P = 0. 083）,respectively. Compared with the group of negative CYFRA21-1,the RR of death of the positive group was 38. 9% higher. Symptomatic therapy as the reference group,the RR of death of patients with surgery,chemotherapy,radiotherapy,combination of chemotherapy and radiotherapy,and comprehensive therapy reduced by 34. 1%（ RR =0. 66,P = 0. 378）,64. 9%（ RR = 0. 35,P〈0. 001）,30. 0%（ RR = 0. 70,P = 0. 298）,60. 3%（ RR = 0. 40,P = 0. 001）and 75. 2%（ RR = 0. 25,P = 0. 002）,respectively. The RR of death of people with smoking history was 64. 5% higher than that of those without smoking（ RR = 1. 65,P = 0. 011）. Conclusions TNM stage,CYFRA21-1,treatment strategy and smoking history are prognostic factors in patients with lung adenocarcinoma.

关 键 词：肺肿瘤 预后 Kaplan-Meier评估 

分 类 号：R734.2[医药卫生—肿瘤]