Osterlind K, Andersen P K
Cancer Res. 1986 Aug;46(8):4189-94.
The relationships between prognostic factors and duration of survival in small cell lung cancer were investigated in a consecutive series of 874 patients treated with combination chemotherapy with or without irradiation. The series included 443 patients with limited and 431 patients with extensive stage disease based on staging including bone marrow examination and peritoneoscopy with liver biopsy but no routine scans. The median durations of survival for the two disease categories were 48 and 30 weeks, respectively. The influence on survival of various pretreatment factors was investigated by use of univariate methods and Cox's multivariate regression model. Patients in each stage were treated according to one of three controlled trials. Variations among the applied treatment regimens did not result in significant differences in duration of survival among patients with limited disease. An alternating regimen was superior to continuous therapy in patients with extensive disease and raised serum lactate dehydrogenase. Prognosis was correlated with disease extent. Surgical resection as well as limited stage disease thus both contributed to survival. Poor performance status, reduced hemoglobin concentration, and raised values for serum lactate dehydrogenase were significantly associated with a reduced duration of survival in both stages. Females with limited disease lived significantly longer than males while advanced age was a negative prognostic factor in extensive disease. Plasma sodium and serum urate were both predictive of survival in limited disease. Proved metastatic disease affecting specific sites or total number of metastatic sites did not carry significant prognostic information in a model including a general variable characterizing stage of disease. Fifty of the 778 patients, on whom the multiple regression model was based, were alive and disease free 2 years after the start of the treatment. Two-year survival rates were strongly correlated to groupings based on prognostic factors, and information about disease extent was not mandatory for predicting the probability of long term disease-free survival.
在一系列连续的874例接受联合化疗（无论是否接受放疗）的患者中，研究了小细胞肺癌预后因素与生存时间的关系。该系列包括443例局限性疾病患者和431例广泛性疾病患者，分期基于骨髓检查、腹腔镜检查及肝活检，但未进行常规扫描。两类疾病的中位生存时间分别为48周和30周。采用单因素方法和Cox多因素回归模型研究了各种预处理因素对生存的影响。每个阶段的患者均按照三项对照试验之一进行治疗。应用的治疗方案之间的差异并未导致局限性疾病患者的生存时间出现显著差异。在广泛性疾病且血清乳酸脱氢酶升高的患者中，交替方案优于持续治疗。预后与疾病范围相关。手术切除以及局限性疾病阶段均对生存有贡献。在两个阶段中，身体状况差、血红蛋白浓度降低以及血清乳酸脱氢酶值升高均与生存时间缩短显著相关。局限性疾病的女性患者生存时间显著长于男性，而高龄是广泛性疾病的不良预后因素。血浆钠和血清尿酸均是局限性疾病生存的预测指标。在包含表征疾病阶段的一般变量的模型中，证实的影响特定部位的转移性疾病或转移部位总数并未携带显著的预后信息。在多元回归模型所基于的778例患者中，有50例在治疗开始后2年仍存活且无疾病。两年生存率与基于预后因素的分组密切相关，对于预测长期无病生存的概率而言，疾病范围信息并非必需。
