Sugiura S, Ando Y, Minami H, Ando M, Sakai S, Shimokata K
First Department of Internal Medicine, Nagoya University School of Medicine, Nagoya, Japan.
Clin Cancer Res. 1997 Jan;3(1):47-50.
This study was performed to determine whether pleural effusion in patients with advanced non-small cell lung cancer (NSCLC) has a negative impact on survival. We evaluated 12 prognostic factors in 197 patients with stage IIIB or IV NSCLC. Each factor was dichotomized, and survival curves calculated by the Kaplan-Meier technique were compared using the log-rank test. The Cox proportional hazards regression model was used to confirm the significance of each prognostic factor selected by univariate analysis. We compared the survival times for stage IIIB with pleural effusion with those of stage IIIB without effusion and stage IV. To determine the impact of the cytological results of the effusion on survival, we compared the survival times for cytologically positive and negative effusions. Univariate analysis identified eight significant prognostic factors: pleural effusion, node status, stage, performance status, weight loss, hemoglobin, albumin, and lactate dehydrogenase. Pleural effusion was selected as a prognostic factor in the multivariate analysis, together with stage, performance status, albumin, and node status. Median survival times for stage IIIB without effusion, stage IIIB with effusion, and stage IV were 15.3, 7.5, and 5.5 months, respectively (P < 0.0001). Survival time for stage IIIB with effusion was significantly different from that of stage IIIB without effusion (P = 0.0129) but not from that of stage IV (P = 0.0797). Among patients with effusion, no significant difference in survival time was observed between cytologically positive and negative effusions. We conclude that pleural effusion in advanced NSCLC is a prognostic factor. Survival time for stage IIIB with pleural effusion is more similar to that of stage IV rather than that of stage IIIB without effusion.
本研究旨在确定晚期非小细胞肺癌（NSCLC）患者的胸腔积液是否对生存有负面影响。我们评估了197例IIIB期或IV期NSCLC患者的12个预后因素。每个因素进行二分法分类，采用Kaplan-Meier技术计算生存曲线，并使用对数秩检验进行比较。采用Cox比例风险回归模型来确认单因素分析中选择的每个预后因素的显著性。我们比较了有胸腔积液的IIIB期患者与无胸腔积液的IIIB期患者及IV期患者的生存时间。为了确定胸腔积液细胞学结果对生存的影响，我们比较了细胞学阳性和阴性胸腔积液患者的生存时间。单因素分析确定了8个显著的预后因素：胸腔积液、淋巴结状态、分期、体能状态、体重减轻、血红蛋白、白蛋白和乳酸脱氢酶。在多因素分析中，胸腔积液与分期、体能状态、白蛋白和淋巴结状态一起被选为预后因素。无胸腔积液的IIIB期、有胸腔积液的IIIB期和IV期患者的中位生存时间分别为15.3个月、7.5个月和5.5个月（P < 0.0001）。有胸腔积液的IIIB期患者的生存时间与无胸腔积液的IIIB期患者有显著差异（P = 0.0129），但与IV期患者无显著差异（P = 0.0797）。在有胸腔积液的患者中，细胞学阳性和阴性胸腔积液患者的生存时间无显著差异。我们得出结论，晚期NSCLC患者的胸腔积液是一个预后因素。有胸腔积液的IIIB期患者的生存时间更类似于IV期患者，而不是无胸腔积液的IIIB期患者。
