Thoracic Oncology Unit, Respiratory Diseases Department, Tenon Hospital, APHP and Paris VI University, Paris.
Respirology. 2012 Jan;17(1):134-42. doi: 10.1111/j.1440-1843.2011.02070.x.
Only a small proportion of patients with advanced non-small cell lung cancer (NSCLC) have a life expectancy greater than 2 years. The aim of this study was to identify the factors associated with long-term survival of patients with advanced NSCLC.
Patients who had received chemotherapy for stage IIIb or IV NSCLC that was not amenable to radiotherapy were studied retrospectively. Data were gathered prospectively from a comprehensive database. Long-term survivors (>2 years) were compared with the other patients, with respect to clinical, biological and tumour-node-metastasis criteria.
Data for 245 consecutive patients were collected. Thirty nine patients (15.9%) survived for more than 2 years. Long-term survivors were more likely to have had metastases at fewer sites (P = 0.008), an absence of bone metastases (P = 0.01), a performance status (PS) of 0-1 at first progression of the tumour (P = 0.002), a tumour that was controlled with first (P < 0.0001) and second-line (P = 0.004) chemotherapy, maintenance therapy (P = 0.001), curative surgery (P < 0.0001), time to first progression of the tumour of >3 months (P < 0.0001), normal LDH levels at diagnosis (P = 0.049), and a haemoglobin concentration >110 g/L at first progression of the tumour (P = 0.02). In multivariate analysis, surgery, maintenance treatment, time to first progression of the tumour of >3 months, a PS of 0-1 at first progression, the number of chemotherapy agents received, and LDH levels, were significant predictors of long-term survival.
Assessment of these factors, and the use of maintenance therapy, when possible, may identify a population of patients with NSCLC that is likely to have a prolonged life expectancy.
仅有一小部分晚期非小细胞肺癌(NSCLC)患者的预期寿命超过 2 年。本研究旨在确定与晚期 NSCLC 患者长期生存相关的因素。
回顾性研究了接受不能放疗的 IIIb 期或 IV 期 NSCLC 化疗的患者。数据从一个全面的数据库中前瞻性收集。将长期幸存者(>2 年)与其他患者进行比较,比较的内容包括临床、生物学和肿瘤-淋巴结-转移(TNM)标准。
共收集了 245 例连续患者的数据。39 例(15.9%)患者存活时间超过 2 年。长期幸存者更有可能存在较少部位的转移(P=0.008)、无骨转移(P=0.01)、肿瘤首次进展时的表现状态(PS)为 0-1(P=0.002)、首次(P<0.0001)和二线(P=0.004)化疗、维持治疗(P=0.001)、根治性手术(P<0.0001)、肿瘤首次进展的时间>3 个月(P<0.0001)、诊断时乳酸脱氢酶(LDH)水平正常(P=0.049)和肿瘤首次进展时血红蛋白浓度>110g/L(P=0.02)。多变量分析显示,手术、维持治疗、肿瘤首次进展的时间>3 个月、首次进展时 PS 为 0-1、接受的化疗药物数量和 LDH 水平是长期生存的显著预测因素。
评估这些因素,并在可能的情况下使用维持治疗,可能会确定一组 NSCLC 患者的预期寿命可能会延长。