Liao Yi, Fan Xianming, Wang Xue
Department of Respiratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China.
Oncol Lett. 2019 Jul;18(1):581-592. doi: 10.3892/ol.2019.10373. Epub 2019 May 20.
The surgical treatment of patients with advanced lung cancer remains controversial. The current study aimed to identify the factors affecting the prognosis of patients with stage IV non-small cell lung cancer (NSCLC) and to clarify the surgery guidelines. A total of 27,725 patients diagnosed with stage IV NSCLC were selected from the Surveillance, Epidemiology, and End Results program between 2010 and 2013. The sex, age, ethnicity, marital status, Tumor-Node-Metastasis stage, radiation therapy received and surgical status of each patient were recorded. Patients were followed up to November 2015. Survival rates were estimated by the Kaplan-Meier method. Single- and multi-factor analyses were performed using the log-rank test and multivariate Cox regression analysis respectively. In the isolated organ metastasis cohort, patients with liver metastasis alone had the worst prognosis, with a median overall survival (OS) of 4 months (liver metastasis vs. other organ metastases; P<0.001). Patients with lung metastasis only had the best prognosis, with a median OS of 8 months (lung metastasis vs. other organ metastases; P<0.001). Furthermore, patients with only one metastasis had the best prognosis, with a median OS of 6 months (single metastasis vs. multiple-organ metastases; P<0.001). The multivariate Cox regression analysis of the isolated-organ metastasis cohort and the multiple-organ metastases cohort revealed that patients who were ≤60 years, female, married, Asian, with N stage, had only bone metastasis, accepted wedge resection or lobectomy of the primary tumor, had surgical procedure to distant lymph node(s), and received beam radiation had an improved prognosis compared with the other patients. Age, sex, tumor type, ethnicity, N stage, number and type of metastatic lesions, surgical treatment of primary and metastatic lesions and radiation therapy are factors which influence the prognosis of patients with stage IV NSCLC. Furthermore, surgery may still benefit these patients.
晚期肺癌患者的外科治疗仍存在争议。当前研究旨在确定影响IV期非小细胞肺癌（NSCLC）患者预后的因素，并阐明手术指南。2010年至2013年期间，从监测、流行病学和最终结果计划中选取了总共27725例诊断为IV期NSCLC的患者。记录了每位患者的性别、年龄、种族、婚姻状况、肿瘤-淋巴结-转移分期、接受的放射治疗和手术状态。对患者随访至2015年11月。采用Kaplan-Meier法估计生存率。分别使用对数秩检验和多变量Cox回归分析进行单因素和多因素分析。在孤立器官转移队列中，仅发生肝转移的患者预后最差，中位总生存期（OS）为4个月（肝转移与其他器官转移；P<0.001）。仅发生肺转移的患者预后最佳，中位OS为8个月（肺转移与其他器官转移；P<0.001）。此外，仅发生一处转移的患者预后最佳，中位OS为6个月（单发转移与多器官转移；P<0.001）。对孤立器官转移队列和多器官转移队列进行的多变量Cox回归分析显示，年龄≤60岁、女性、已婚、亚洲人、N分期、仅发生骨转移、接受原发性肿瘤楔形切除术或肺叶切除术、对远处淋巴结进行手术以及接受束状放疗的患者与其他患者相比预后有所改善。年龄、性别、肿瘤类型、种族、N分期、转移灶的数量和类型、原发性和转移性病变的手术治疗以及放射治疗是影响IV期NSCLC患者预后的因素。此外，手术可能仍使这些患者获益。
