Dediu Mircea, Crisan Emilia, Radut Maria, Tarlea Alin, Median Dragos, Alexandru Aurelia, Vremes Georgeta, Gal Cristian
Medical Oncology Department, Institute of Oncology Bucharest, Bucharest, Romania.
Lung Cancer. 2009 Feb;63(2):271-6. doi: 10.1016/j.lungcan.2008.05.007. Epub 2008 Jun 20.
For lung cancer, the TNM staging system included atelectasis (At) as a negative prognostic factor, within the T category. However, according to our clinical experience, we observed the opposite. The aim of the study was to evaluate the influence of At on patient outcome for unresectable stage III and IV non-small cell lung cancer (NSCLC).
We prospectively evaluated the patient survival data, in correlation with the presence, At(+), or absence, At(-), of At. A distinct analysis according to stage was preplanned. Univariate and multivariate analysis were performed to refine the prognostic significance of At.
We evaluated 1352 consecutively treated patients, during 1997-2004. Sixty-eight patients (5%) were identified with At, of which 46/592 (8%) were in stage III, and 22/760 (3%) were in stage IV. The survival data were significantly better for patients At(+) vs. At(-); median overall survival (OS): 21 months (95% confidence interval [CI], 12.37-29.63) vs. 10 months (95% CI, 9.25-10.75) (p<0.001), and median progression free survival (PFS):17 months (95% CI, 11.71-22.29) vs. 7 months (95% CI, 6.48-7.52) (p<0.001). The most consistent difference, favoring patients At(+), was noted for patients in stage III, with OS: 24 months (95% CI, 18.65-29.35) vs. 14 months (95% CI, 12.43-15.57) (p<0.001), and PFS: 19 months (95% CI, 12.11-25.89) vs. 8 months (95% CI, 6.89-9.02) (p<0.001). In stage IV, we noted a non-significant trend toward improved survival in patients At(+); OS: 16 months (95% CI, 4.49-27.51) vs. 9 months (95% CI, 8.51-9.49) (p=0.21), and PFS: 8 months (95% CI, 5.80-10.20) vs. 6 months (95% CI, 5.36-6.64) (p=0.12). The multivariate analysis showed that At, stage and ECOG performance status were independent predictors for survival.
At predicts a better survival in patients with advanced NSCLC. The prognostic value is more stringent for stage III patients. Inclusion of At as a negative prognostic factor in the TNM staging system warrants further evaluation.
对于肺癌，TNM分期系统在T分类中将肺不张（At）列为不良预后因素。然而，根据我们的临床经验，我们观察到的情况却相反。本研究的目的是评估肺不张对不可切除的Ⅲ期和Ⅳ期非小细胞肺癌（NSCLC）患者预后的影响。
我们前瞻性地评估了患者的生存数据，并将其与肺不张的存在（At(+)）或不存在（At(-)）相关联。预先计划了根据分期进行的单独分析。进行单因素和多因素分析以明确肺不张的预后意义。
我们评估了1997年至2004年期间连续治疗的1352例患者。68例（5%）患者被确定存在肺不张，其中Ⅲ期患者46/592例（8%），Ⅳ期患者22/760例（3%）。肺不张（At(+)）患者的生存数据明显优于肺不张阴性（At(-)）患者；总生存期（OS）中位数：21个月（95%置信区间[CI]，12.37 - 29.63）对比10个月（95%CI，9.25 - 10.75）（p<0.001），无进展生存期（PFS）中位数：17个月（95%CI，11.71 - 22.29）对比7个月（95%CI，6.48 - 7.52）（p<0.001）。在Ⅲ期患者中，最一致的差异是肺不张（At(+)）患者的情况更好，OS为24个月（95%CI，18.65 - 29.35）对比14个月（95%CI，12.43 - 15.57）（p<0.001），PFS为19个月（95%CI，12.11 - 25.89）对比8个月（95%CI，6.89 - 9.02）（p<0.001）。在Ⅳ期患者中，我们注意到肺不张（At(+)）患者的生存改善趋势不显著；OS为16个月（95%CI，4.49 - 27.51）对比9个月（95%CI，8.51 - 9.49）（p = 0.21），PFS为8个月（95%CI，5.80 - 10.20）对比6个月（95%CI，5.36 - 6.64）（p = 0.12）。多因素分析表明，肺不张、分期和ECOG体能状态是生存的独立预测因素。
肺不张预示晚期NSCLC患者有更好的生存。对于Ⅲ期患者，预后价值更为显著。在TNM分期系统中将肺不张列为不良预后因素值得进一步评估。
