Ⅳ期非小细胞肺癌化疗同期胸部三维适形放疗基于常规血液学指标建立的预后评分模型探讨  

A prognostic scoring model of stage Ⅳ NSCLC for concurrent chemo therapy and thoracic three-dimensional radiotherapy based on routine hematological index

作　　者：徐世林 卢冰 苏胜发 欧阳伟炜 胡银祥 马筑 李青松 耿一超 杨文刚 赵朝芬 刘凌枫 XU Shi-lin;LU Bing;SU Sheng-fa;OUYANG Wei-wei;HU Yin-xiang;MA Zhu;LI Qing-song;GENG Yi-chao;YANG Wen-gang;ZHAO Chao-fen;LIU Ling-feng(Department of Oncology,Affiliated Hospital of Guizhou Medical College & Guizhou Province Tumor Hospital,Guiyang 550004,Guizhou,China)

机构地区：[1]贵州医科大学附属医院肿瘤科·贵州省肿瘤医院肿瘤科

出　　处：《川北医学院学报》2019年第4期329-334,共6页Journal of North Sichuan Medical College

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

摘　　要：目的:基于常规血液学指标建立Ⅳ期非小细胞肺癌(NSCLC)化疗同期胸部三维适形放疗(3DCRT)的预后模型。方法:回顾性分析230例接受化疗同期3DCRT的Ⅳ期NSCLC临床资料及治疗前1周内的血液学指标,Kaplan-Meier法计算生存率,Log-rank法组间比较及单因素预后分析,根据多因素Cox比例风险回归模型分析的偏回归系数β值对独立危险因素赋值并建立临床预测模型。结果:全组患者中位生存时间和中位无进展生存期分别为12.4个月和7.1个月,1、2、3年OS分别为55.2%、19.8%和11%。单因素分析显示吸烟史、体重下降、白细胞、血小板、白蛋白、中性粒细胞绝对值、纤维蛋白原、转移器官数目、脑转移、骨转移、化疗周期数对OS有影响( P =0.013、0.03、0.003、0.044、0.011、0.001、0.001、0.014、0.02、0.023、0.001);多因素Cox比例风险回归模型分析显示中性粒细胞绝对值、纤维蛋白原、白蛋白、脑转移、化疗周期数是OS的独立的预后因素(HR:2.502、1.635、2.020、1.517和2.107;P <0.05)。根据评分将NSCLC患者分为:低危组、中危组、高危组,各组对应的1年和2年生存率分别为76.3%、45.4%、16.1%和20.3%、16%、3.2%(χ 2 =37.59,P <0.001)。结论:中性粒细胞绝对值、纤维蛋白原、白蛋白、脑转移、化疗周期数是Ⅳ期NSCLC化疗同期胸部3DCRT的独立预后因素,基于血液学指标建立的预测模型能很好的预测Ⅳ期NSCLC患者预后。Objective: To establish a prognostic scoring model for stage Ⅳ non-small cell lung cancer (NSCLC) reated with concurrent chemotherapy and thoracic three-dimensional radiotherapy based on routine Hematological Index. Methods: Clinical records and Hematological Index within 1 week of pre-treatment were collctcted and analyzed for 230 stage Ⅳ NSCLC treated with concurrent chemotherapy and CCTTRT.The survival rate was calculated by Kaplan-Meier method,the prognostic factor was analyzed by univariate Log-rank test and multivariate Cox regression.The scoring system was established by assigning the partial regression coefficient β of independent risk factors. Results: The median survival time and median progression-free survival time were 12.4 m and 7.1 m,respectively.OS of 1,2 and 3 years were 55.2%,19.8% and 11%,respectively.Univariate analysis showed that smoking history,weight loss,white blood cells,platelets,albumin,neutrophils,fibrinogen,number of metastatic organs,brain metastasis,bone metastasis and number of chemotherapy cycles had effects on OS ( P =0.013,0.03,0.003,0.044,0.011,0.001,0.014,0.02,0.023,0.001),multivariate Cox analysis showed neutrophils,fibrinogen,albumin,brain metastasis and the number of chemotherapy cycles were independent prognostic factors for OS (HR:2.502,1.635,2.020,1.517,2.107, P <0.05).According to the score,NSCLC patients were divided into low-risk group,medium-risk group and high-risk group.The 1-year and 2-year survival rates were 76.3%,45.4%,16.1% and 20.3%,16% and 3.2%,respectively in the low-risk group,medium-risk group and high-risk group (χ 2= 37.59,P <0.001). Conclusion: The neutrophils,fibrinogen,albumin,brain metastasis and the number of chemotherapy cycles are independent prognostic factors of Ⅳ NSCLC treated with concurrent chemotherapy and CCTTRT,the scoring model based on Hematological Index can predict prognosis for the patients with stage Ⅳ NSCLC.

关 键 词：非小细胞肺癌 同期化放疗法 放射疗法 三维 血液学指标 预后 

分 类 号：R734.2[医药卫生—肿瘤]