影响晚期非小细胞肺癌治疗效果的临床因素分析

目的 分析157 例晚期非小细胞肺癌(NSCLC)的临床资料,探讨影响晚期NSCLC 疗效的相关因素.方法 用回顾性分析的方法,将2006 年1 月至2008 年1 月在大连医科大学附属第二医院肿瘤科就诊的晚期NSCLC 患者纳入研究,分析近期和远期疗效以及影响疗效的相关因素.步骤:(1)统计一线治疗(化疗和靶向)的疾病进展时间(TTP),以性别、龄、卡氏评分、病理类型作为变量,探讨各变量对近期疗效的影响;(2)入组患者以生存期(OS)分成3 组,A 组OS ＜12 个月,组12 个月＜OS ＜24 个月,C 组OS ＞24 个月.分别以性别、年龄、卡氏评分、临床分期、病理类型、有无恶性胸腔积液、转移位数目、是否综合治疗为变量进行分层分析,探讨各变量对远期疗效的影响.结果 157 例患者,女53 例(33.8%),男104(66.2%);鳞癌46 例(29.3%),腺癌99 例(63.1%),其他病理类型12 例(7.6%);Ⅲb 期60 例(38.2%),Ⅳ期97(61.8%).一线化疗中位TTP 4 个月,一线靶向中位TTP 4 个月.中位OS 13 个月,12 个月生存率58.0%,24 个月生存25.5%.卡氏评分是一线化疗TTP 的影响因素,卡氏评分≥70 分的患者TTP 较长,而性别、年龄、病理类型变量均未能影TTP.一线靶向治疗和一线化疗的近期疗效相近.性别、年龄和卡氏评分均是远期疗效的影响因素,年轻、女性、卡氏评分≥70 分的患者12 个月生存率及24 个月生存率较老年、男性、卡氏评分＜70 分的患者高.病理类型和转移部位数目对OS 的响无统计学意义;Ⅲb 期和Ⅳ期在OS 是否大于12 个月分组中有统计学意义;157 例患者中有无恶性腔积液对OS 的影响亦统计学意义.综合治疗优于单一治疗或不治疗.结论 (1)卡氏评分是一线化疗TTP 的影响因素;一线靶向治疗和化疗的期疗效相近;(2)性别、年龄、卡式评分是远期疗效的影响因素;(3)Ⅲb 期和Ⅳ期在OS 是否大于12 个月分组中有统计学义;(4)综合治疗优于单一治疗或不治疗.

Analysis of the clinical factors in the treatment of advanced non-small cell lung cancer

Objective To investigate the clinical factors related to the treatment efficacy of advanced non-small cell lung cancer （NSCLC） by analyzing the clinical data of 157 patients with NSCLC.Methods The patients with advanced NSCLC visiting 2nd Affiliated Hospital of Dalian Medical Oncology in Jan.2006-Jan.2008 were included in this retrospective analysis.All relevant factors which have effected on the short-and long-term treatment efficacy were analyzed.The procedures are：1.Statistics analysis of time to progression （TTP） after first-line treatment （chemotherapy and targeted therapy） to investigate the effect of gender,age,Karnofsky score and pathological type on the short-term treatment efficacy of advanced NSCLC.2.Patients were divided into three groups according to survival time,A：less than 12 months;B：more than 12 months and less than 24 months;C：more than 24 months.Stratified analysis were done to analyze the effect of gender,age,Karnofsky score,clinical stage,histological type,malignant pleural effusion,number of metastasis and the combined therapy on the long-term treatment efficacy of NSCLC.Results 157 patients,female 53（33.8%） and male 104（66.2%）;squamous cell carcinoma 46 cases （29.3%）,adenocarcinoma 99（63.1%）,and others 12（7.6%）;stage Ⅲb 60（38.2%） and stage Ⅳ 97（61.8%）;median TTP is 4 months after first-line chemotherapy and first-line targeted therapy;the overall median survival is 13 months;12-month survival rate is 58.0%,and 24-month survival rate is 25.5%;Karnofsky score has impact on the TTP after first-line chemotherapy,the patients having a Karnofsky score ≥70 had longer TTP.Sex,age,and pathological type failed to affect TTP.First-line targeted therapy has similar short-term efficacy as first-line chemotherapy.Age and Karnofsky score were influencing factors on the long-term efficacy of advanced NSCLC.Both 12-and 24-month survival rate were higher in young,female,Karnofsky score ≥70 patients than older,male,and Karnofsky score 〈70 ones.Pathological type,number of metastasis have no impact on survival;Stage Ⅲb and Ⅳ show significant difference in the impact on the survival more than 12 months.Malignant effusion does not affect survival.Combined treatment is superior to single or no therapy.Conclusions 1.Karnofsky score has impact on the TTP after first-line chemotherapy;First-line targeted therapy has similar efficacy as first-line chemotherapy.2.Sex,Age and Karnofsky score were influencing factors on the long-term efficacy 3.Stage Ⅲb and Ⅳ show significant difference in the impact on more-than-12-month survival;4.combined therapy is superior to single or no therapy.