Hespanhol V, Queiroga H, Magalhães A, Santos A R, Coelho M, Marques A
Porto Medical School, Pneumology, H.S. João, Portugal.
Lung Cancer. 1995 Dec;13(3):253-67. doi: 10.1016/0169-5002(95)00497-1.
The authors studied the influence on survival of 21 clinical, anatomical, haematological and biochemical factors evaluated, at diagnosis, of 411 patients (pts) with advanced Non Small Cell Lung Cancer (NSCLC) followed in our department between 1984 and 1990. Most of the patients were male (347--84.4%) and only 64 (15.6%) were females. Median age was 62 years, but was slightly higher in females. Only 34 patients were aged under 45 years. Squamous cell carcinoma (215 pts--52%) and adenocarcinoma (152 pts--37%) were the most frequent histologic types. Performance status was poor--only 103 (25%) continued active; 120 (29%) spent at least half of the time in bed; 188 (46%) were severely limited. After staging, 179 (44%) presented locally advanced disease (stage IIIB) and 232 (56%) metastatic dissemination (stage IV). Therapy was defined by the oncologic group according to individual characteristics and based on clinical grounds. Anti-neoplastic therapy was performed in 225 (55%), chemotherapy alone in 121 (30%), radiation therapy alone in 67 (16%), and sequential combined treatment (chemotherapy and thoracic radiation) in 37 (9%). Until 1987, the main chemotherapy regimen was MACC (Metrotrexate + Adriamycine + Cyclophosphamide + Lomustin), afterwards VP(M) (Cisplatin + Vimblastin + Mitomycine). Radiation therapy was performed using Co60, 2 Gy/day, 5 days a week, for 4 weeks (approximately 45 Gy total). The response rate was poor--four complete responses (2%), 42 (19%) partial responses. The overall median survival was 4.3 months and only 5% of patients were alive after 18 months of follow up. Prognostic importance of each characteristic studied was initially done by unifactorial analysis, followed by multifactorial analysis according to two methods: Cox proportional hazards model and recursive partitioning amalgamation--RECPAM. Regardless of the method used, the main determinants of survival were found to be performance status (Zubrod), weight loss and serum albumin. Other factors such as the staging (presence or absence of metastasis), lymphocytes, lactic dehydrogenase, and hoarseness were also significant. It is noteworthy that age and histological type were irrelevant; sex and hoarseness only proved important when integrated within a multifactorial model. The overall prognostic evaluation and therapeutic decision of advanced NSCLC patients could be improved by combining the prognostic value of TNM with that of performance status, weight loss and serum albumin. These prognostic guidelines must be taken into account when designing new clinical trials.
作者研究了1984年至1990年间在我们科室接受随访的411例晚期非小细胞肺癌（NSCLC）患者在诊断时评估的21项临床、解剖学、血液学和生化因素对生存的影响。大多数患者为男性（347例，占84.4%），女性仅64例（占15.6%）。中位年龄为62岁，但女性略高。只有34例患者年龄在45岁以下。鳞状细胞癌（215例，占52%）和腺癌（152例，占37%）是最常见的组织学类型。体能状态较差——只有103例（25%）仍能活动；120例（29%）至少一半时间卧床；188例（46%）活动严重受限。分期后，179例（44%）表现为局部晚期疾病（IIIB期），232例（56%）有远处转移（IV期）。治疗由肿瘤学小组根据个体特征并基于临床依据确定。225例（55%）接受了抗肿瘤治疗，其中121例（30%）仅接受化疗，67例（16%）仅接受放疗，37例（9%）接受序贯联合治疗（化疗和胸部放疗）。直到1987年，主要化疗方案是MACC（甲氨蝶呤+阿霉素+环磷酰胺+洛莫司汀），之后是VP(M)（顺铂+长春花碱+丝裂霉素）。放疗使用钴60，每天2 Gy，每周5天，共4周（总剂量约45 Gy）。缓解率较低——4例完全缓解（2%），42例部分缓解（19%）。总体中位生存期为4.3个月，随访18个月后只有5%的患者存活。最初通过单因素分析研究每个特征的预后重要性，然后根据两种方法进行多因素分析：Cox比例风险模型和递归分割合并法（RECPAM）。无论使用何种方法，发现生存的主要决定因素是体能状态（Zubrod评分）、体重减轻和血清白蛋白。其他因素如分期（有无转移）、淋巴细胞、乳酸脱氢酶和声音嘶哑也具有显著性。值得注意的是，年龄和组织学类型无关；性别和声音嘶哑仅在多因素模型中综合考虑时才被证明具有重要性。将TNM的预后价值与体能状态、体重减轻和血清白蛋白的预后价值相结合，可以改善晚期NSCLC患者的总体预后评估和治疗决策。在设计新的临床试验时必须考虑这些预后指南。
