Cağlayan Benan, Fidan Ali, Salepçi Banu, Kiral Nesrin, Torun Elif, Salepçi Taflan, Mayadağli Alparslan
Dr. Lütfi Kirdar Kartal Education and Research Hospital, Department of Chest Disease, Istanbul, Turkey.
Tuberk Toraks. 2004;52(4):323-32.
In this study, 304 stage III-B and IV non-small cell lung cancer (NSCLC) cases diagnosed and followed up in our hospital between January 2000 and December 2002 are retrospectively analysed. The effects of demographic, clinical, laboratory findings and different therapeutic modalities on survival were investigated. Of the cases, 31 (10.2%) were women, 273 (89.8%) were men and mean age was 60.59 +/- 10.73. Analysis by the Kaplan-Meier method revealed that median survival was 6.0 +/- 0.5 (95% CI: 5.1-6.9) months and 12 and 24-month survival rates were 25.27 +/- 2.99% and 11.48 +/- 2.77% respectively. By univariate analysis of 33 parameters, 12 of them were found to be effective on survival and this relationship was statistically significant (p< 0.05). These parameters indicating poor prognosis were age > 70, ECOG performance score > 1, dyspnea, peripheral lymphadenomegaly (LAM), mediastinal invasion, pleural effusion, distant metastasis, elevated serum LDH, CA 19.9, CA-125 values, not receiving curative radiotherapy (RT) (> 50 Gy) or chemotherapy (CT). A multivariate analysis by Cox regression method revealed that advanced age, mediastinal invasion and metastatic disease were not independent prognostic factors on survival whereas ECOG performance score > 1 (p= 0.000), absence of CT (p= 0.000) and curative RT (p= 0.018), dyspnea (p= 0.035), peripheral LAM (p= 0.022) and pleural effusion (p= 0.043) were independent prognostic factors on survival.
本研究对2000年1月至2002年12月期间在我院确诊并随访的304例Ⅲ - B期和Ⅳ期非小细胞肺癌（NSCLC）病例进行回顾性分析。研究了人口统计学、临床、实验室检查结果及不同治疗方式对生存的影响。病例中，女性31例（10.2%），男性273例（89.8%），平均年龄为60.59±10.73岁。采用Kaplan - Meier法分析显示，中位生存期为6.0±0.5（95%可信区间：5.1 - 6.9）个月，12个月和24个月生存率分别为25.27±2.99%和11.48±2.77%。对33项参数进行单因素分析，发现其中12项对生存有影响，且这种关系具有统计学意义（p<0.05）。这些提示预后不良的参数包括年龄>70岁、东部肿瘤协作组（ECOG）体能状态评分>Ⅰ级、呼吸困难、外周淋巴结肿大（LAM）、纵隔侵犯、胸腔积液、远处转移、血清乳酸脱氢酶（LDH）升高、CA19.9、CA - 125值升高、未接受根治性放疗（RT）（>50 Gy）或化疗（CT）。采用Cox回归法进行多因素分析显示，高龄、纵隔侵犯和转移性疾病并非生存的独立预后因素，而ECOG体能状态评分>Ⅰ级（p = 0.000）、未进行CT治疗（p = 0.000）和根治性RT治疗（p = 0.018）、呼吸困难（p = 0.035）、外周LAM（p = 0.022）和胸腔积液（p = 0.043）是生存的独立预后因素。
