非小细胞肺癌根治术后生存分析  

Survival analysis after radical resection in non-small cell lung cancer patients

作　　者：张真榕[1] 梁朝阳[1] 冯宏响[1] 肖飞[1] 郭永庆[1] 石彬[1] 宋之乙[1] 田燕雏[1] 甘继瑞 刘德若[1] 

机构地区：[1]中日友好医院胸外科,北京100029

出　　处：《中华肿瘤防治杂志》2016年第13期872-878,883,共8页Chinese Journal of Cancer Prevention and Treatment

基　　金：国家临床重点专科建设项目(〔2011〕873)

摘　　要：目的肿瘤的局部复发和远处转移是非小细胞肺癌(non-small cell lung cancer,NSCLC)治疗失败和死亡的最主要原因。本研究评价与NSCLC患者复发/转移后生存时间(postrecurrence survival,PRS)和总生存率(overall survival,OS)相关的临床病理因素。方法回顾性分析2005-01-01-2011-12-31于中日友好医院胸外科行肺叶切除+纵隔淋巴结清除的160例NSCLC患者临床资料及随访资料,病理分期为pⅠA~ⅢA期且经过随访均发生局部复发或者远处转移,应用SPSS 20.0对资料进行统计分析。应用Kaplan-Meier曲线及Cox回归对根治性切除术后OS和PRS相关风险因素进行分析。结果 160例患者平均年龄62岁,其中鳞癌41例,腺癌101例,其他类型NSCLC 18例(腺鳞癌11例,大细胞癌7例)。随访终点43例发生局部复发,93例发生远处转移,24例同时发生局部复发和远处转。入组患者中位生存时间45个月;复发/转移后中位生存时间20个月。单因素分析结果显示,性别、TNM分期和复发/转移与OS有相关性,P<0.05;年龄、吸烟指数、吸烟史、病理类型、淋巴血管浸润、复发/转移时间≤12个月、复发转移时间≤24个月、术后有无(放)化疗以及复发后有无治疗亦与OS具有相关性,P<0.01。多因素分析结果显示,年龄(HR=0.23,95%CI:0.14~0.38,P<0.01)、吸烟指数(HR=11.28,95%CI:2.53~50.26,P<0.01)、TNM分期(HR=1.50,95%CI:1.08~2.07,P<0.05)、复发时间≤24个月(HR=0.31,95%CI:0.16~0.60,P<0.01)、术后有无放化疗(HR=0.82,95%CI:0.68~0.99,P<0.05)、复发后有无治疗(HR=1.40,95%CI:1.24~1.58,P<0.01)为影响OS的独立危险因素。单因素分析结果显示,年龄、吸烟指数、病理类型、TNM分期、术后有无(放)化疗和复发后有无治疗与PRS有相关性,P<0.01;复发/转移亦与PRS有相关性,P<0.05。多因素分析结果显示,年龄(HR=0.26,95%CI:0.18~0.45,P<0.01)、吸烟指数(HR=1.73,95%CI:1.12~2.68,P<0.05)、术后有无(放)化疗(HR=0.77,95%CI:0.66~0.91,P<0.01)、复发后有无OBJECTIVE Local recurrence and distant metastasis are the most important reasons of therapeutic fail- ure of non-small cell lung cancer （NSCLC） and the predominant causes of cancer specific death. The objective of this study was to evaluate the relevant clinical and pathological factors of postrecurrence survival （PRS） and overall survival （OS） of NSCLC. METHODS Recurrence or metastasis data of 160 pathological ⅠA-- Ⅲ A NSCLC patients who under- went lobectomy and lymphadeneetomy in our department between 2005.1 and 2011.12 were reviewed. All data analysis were finished with SPSS 20.0. Kaplan-Meier was used in survival analysis, and Cox regression was used for multivariate analysis of both PRS and OS. Significant difference between groups could be found if P value was less than 0.05. RE- SULTS The average age of 160 patients was 62 years old, including 101 adenocarcenoma, 41 squamous cell lung cancer and 18 other NSCLC（ll adenosquamous cell cancer and 7 large cell lung cancer）. During follow-up, local recurrence was found in 43 patients. Distant metastases was found in 93 patients. Local-distant metastases was found in 24 patients. The total median survival and postreeurrence median survival were 45 and 20 months respectively. Univariate analysis showed sex and TNM stage （P^0.05） were relevant to OS. Also age, smoke index, smoke history, histology, lymph-vascular invasion, recurrence/metastasis status, recurrence/metastasis less than 12 months, recurrence/metastasis less than 24 months, with or without postsurgical therapy, with or without postreeurrence therapy （P〈0.01） were relevant to OS. Cox regression showed age （HR=0.23, 95%CI=0. 14-0.38,P〈0.01）, smoke index （HR=ll. 28, 95%CI： 2.53--50.26,P〈0.01）, TNM stage （HR=1.50, 95GCI： 1. 08--2. 07,P〈0. 05）, recurrence/metastasis less than 24 month （HR=0.31, 95% CI 0.16--0.60,P〈0.01）, with or without postsurgieal therapy（HR=0.82, 95%CI：0.68--0.99, P%0.05）, with or without postrecurrence therapy （HR= 1.40

关 键 词：非小细胞肺癌 总生存率 复发/转移后生存率 预后 

分 类 号：R734.2[医药卫生—肿瘤]