两种因素对晚期NSCLC患者预后的影响

目的本研究旨在比较年龄与合并症对晚期无手术或根治性放疗指征的Ⅲb或Ⅳ期非小细胞肺癌（non-small cell lung cancer,NSCLC）患者的预后的影响。方法回顾性分析同济大学附属肺科医院肿瘤科2005年1月至2005年12月确诊的行为状态较好（performance status,PS≤1）且接受化疗的晚期NSCLC患者,并根据年龄将患者分为非老年组（年龄〈70岁）和老年组（年龄≥70岁）以及合并症状态分为无（0）、轻度（12）和重度（≥3）组,分析其与临床特征、治疗经过和预后之间的关系。结果共有422例患者进入本研究,其中非老年和老年患者分别为295例（69.9%）和127例（30.1%）,无合并症和轻、重度合并症患者分别为209例（49.5%）、174例（41.2%）和39例（9.2%）。不同年龄组和合并症组患者的治疗措施之间均未见显著性差异。在生存时间上,非老年组和老年组患者的中位生存时间分别为12.0个月（11.4-12.6个月）和10.0个月（8.2-11.8个月）,1年生存率为49.7%和39.6%（Log-Rank,P=0.416）;无、轻和重度合并症组患者的中位生存时间分别为12．1个月（11.6-12.6个月）、11.8个月（10.1-13.5个月）和8.0个月（6.2-9.8个月）,1年生存率为50.1%、47.8%和23.8%（Log-Rank,P=0.012）。单因素和多因素COX回归分析发现,年龄和轻度合并症均不是晚期NSCLC患者的独立预后因素,仅重度合并症才是增加晚期NSCLC患者死亡风险独立的预后因素,RR（95%CI）：1.96（1.03-3.25）,2.19（1.13-4.74）,P=0.044,0.032。结论年龄和轻度合并症均不是晚期NSCLC患者的独立预后因素,仅重度合并症是影响晚期NSCLC患者生存预后的不良预后因素。

Influence of age and comorbidity on survival of patients with advanced non-small-cell lung cancer

Objective This study was designed to identify the influence of age and comorbidity on the survival of patients with advanced NSCLC who had a good performance status（PS≤1） and received chemotherapy for at least 1 cycle.Methods The clinical characteristics,treatment strategies and survival features of patients were retrospectively analyzed in this Oncology Department between 2005.1-2005.12.These patients were stratified by age as younger（〈70）,elderly（≥70） groups and by number of comorbidities as none（0）,mild（12） and severe（≥3） groups.Results A total of 422 patients were enrolled in this study： 295（69.9%） patients belonging to younger group and 127（30.1%） to elderly group;and the number of patients with none,mild or sever comorbidity being 209（49.5%）,174（41.2%） and 39（9.2%）,respectively.The 1-year-survival rates in the younger and elderly groups were 49.7% and 39.6%（Log-Rank,P=0.416）,respectively.In the none,mild and severe comorbidity groups,the 1-year-survival rates were 50.1%,47.8% and 23.8%,respectively（Log-Rank,P=0.012）.In univariate and multivariate Cox model analysis,only severe comorbidity was an independent hazard factor for survival of the patients with advanced NSCLC,RR（95%CI）： 1.96（1.03-3.25）,2.19（1.13-4.74）,P=0.044,0.032.Conclusion Only severe comorbidity is an independent factor of survival of these patients with advanced NSCLC.