Gullón J, Fernández R, Rubinos G, Medina A, Suárez I, González I
Sección de Neumología, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain.
Arch Bronconeumol. 2001 Dec;37(11):477-81. doi: 10.1016/s0300-2896(01)75126-5.
This study of advanced-stage non-small cell bronchogenic carcinoma aimed 1) to identify prognostic factors collected at the moment of diagnosis, 2) to determine whether weight loss is a useful parameter to screen for subjects who will receive greater benefit from anticancer therapy.Patients and methods. Eighty-one patients were enrolled after diagnosis of stage III-B and IV non-small cell bronchogenic carcinoma and levels of activity < 2 according to Eastern Co-operative Oncology Group classification. The variables studied were age, sex, smoking history, associated disease, clinical data (weight loss, dyspnea, superior vena cava syndrome), laboratory parameters [hemoglobin, serum albumin, total lymphocytes, serum lactate dehydrogenase (LDH), calcium and liver enzymes], tumor-node-metastasis (TNM) staging, histologic type, activity, treatment received and survival in weeks. The results were analyzed in two groups: 1) the general group consisting of results for all patients, and 2) the no-weight-loss group consisting of results for those whose weight had been stable. Student t, chi-squared, Kaplan Meier, log-rank and Cox's regression model were used to analyze data and survival.
Mean survival was 29 weeks (21-37). Survival was significantly related to weight loss, total lymphocytes, serum LDH, TNM and activity level in the general group. Only two factors continued to have prognostic value in the multivariate study: weight loss (OR: 1.48 (1.14-1.92), p = 0.002) and TNM (OR: 0.72 (0.54-0.96), p = 0.02). Among the patients with no weight loss, treatment received and TNM were significantly related to survival in univariable analysis and in Cox's regression model.
In our experience with advanced lung cancer subjected to anticancer therapy, the presence of weight loss is the variable with the greatest prognostic value, such that it may be useful to consider it routinely, along with activity level, to try to identify patients who will receive the most benefit from cytostatic treatment.
本研究针对晚期非小细胞支气管癌，旨在：1）确定诊断时收集的预后因素；2）确定体重减轻是否是筛选能从抗癌治疗中获益更多患者的有用参数。
患者与方法。81例经诊断为Ⅲ - B期和Ⅳ期非小细胞支气管癌且根据东部肿瘤协作组分类活动水平<2的患者入组。研究变量包括年龄、性别、吸烟史、相关疾病、临床数据（体重减轻、呼吸困难、上腔静脉综合征）、实验室参数[血红蛋白、血清白蛋白、总淋巴细胞、血清乳酸脱氢酶（LDH）、钙和肝酶]、肿瘤 - 淋巴结 - 转移（TNM）分期、组织学类型、活动水平、接受的治疗以及以周为单位的生存期。结果在两组中进行分析：1）由所有患者结果组成的总体组；2）由体重稳定患者结果组成的无体重减轻组。采用学生t检验、卡方检验、Kaplan - Meier法、对数秩检验和Cox回归模型分析数据和生存期。
平均生存期为29周（21 - 37周）。在总体组中，生存期与体重减轻、总淋巴细胞、血清LDH、TNM和活动水平显著相关。在多变量研究中，只有两个因素继续具有预后价值：体重减轻（比值比：1.48（1.14 - 1.92），p = 0.002）和TNM（比值比：0.72（0.54 - 0.96），p = 0.02）。在无体重减轻的患者中，接受的治疗和TNM在单变量分析和Cox回归模型中与生存期显著相关。
根据我们对抗癌治疗的晚期肺癌患者的经验，体重减轻的存在是具有最大预后价值的变量，因此，将其与活动水平一起常规考虑，可能有助于识别能从细胞毒性治疗中获益最多的患者。
