Nomogram for overall survival of patients with progressive metastatic prostate cancer after castration.

PURPOSE: To develop a pretreatment prognostic model for survival of patients with progressive metastatic prostate cancer after castration using parameters that are measured during routine clinical management. PATIENTS AND METHODS: Pretreatment clinical and biochemical determinants from 409 patients enrolled onto 19 consecutive therapeutic protocols from June 1989 through January 2000 were evaluated. The factors selected were age, Karnofsky performance status (KPS), hemoglobin (HGB), prostate-specific antigen (PSA), lactate dehydrogenase (LDH), alkaline phosphatase (ALK), and albumin. These factors were combined in an accelerated failure time regression model to produce a nomogram to predict median, 1-year, and 2-year survival. The nomogram was validated internally and externally using data from a multicenter randomized trial of suramin plus hydrocortisone versus hydrocortisone alone. RESULTS: The median survival of the entire group was 15.8 months (range, 0.9 to 77.8 months); 87% have died. In multivariable analysis, KPS, HGB, ALK, albumin, and LDH were significantly associated with survival (P <.05), whereas age and PSA were not. All seven factors were included in the nomogram. When applied to the external validation data set, the nomogram achieved a concordance index of 0.67. Calibration plots suggested that the nomogram was well calibrated for all predictions. CONCLUSION: A nomogram derived from pretreatment parameters that are measured on a routine basis was constructed. It can be used to predict the median, 1-year, and 2-year survival of patients with progressive castrate metastatic disease with reasonable accuracy. The information is useful to assess prognosis, guide treatment selection, and design clinical trials.     

Clinical Outcomes and Prognostic Factors Associated with the Response to Erlotinib in Non-Small-Cell Lung Cancer Patients with Unknown EGFR Mutational Status

Background: The efficacy of erlotinib is controversial in patients with unknown EGFR mutational status.The aim of this study was to identify the clinicopathological factors that are predictive of erlotinob treatmentoutcomes for NSCLC patients with unknown EGFR mutational status. Materials and Methods: A retrospectiveanalysis of 109 patients with advanced NSCLC who had previously failed at least one line of chemotherapy andreceived subsequent treatment with erlotinib (150 mg/day orally) was performed. A Cox proportional hazardmodel for univariate and multivariate analyses was used to identify the baseline clinical parameters correlatingwith treatment outcome, expressed in terms of hazard ratios (HRs) and 95% confidence intervals. Results: Themedian treatment duration was 15 weeks (range, 4-184). The disease control rate was 55%, including diseasestability for ≥3 months for 40% of the patients. Median progression-free survival and median overall survival(OS) were 4.2 and 8.5 months, respectively. The Cox model indicated that an Eastern Cooperative OncologyGroup performance status (ECOG PS) ≥2 (HR 3.82; p<0.001), presence of intra-abdominal metastasis (HR 3.42;p=0.002), 2 or more prior chemotherapy regimens (HR 2.29; p=0.021), and weight loss >5% (HR 2.05; p=0.034)were independent adverse prognostic factors for OS in NSCLC patients treated with erlotinib. Conclusions: Thisstudy suggests that NSCLC patients should be enrolled in erlotinib treatment after a first round of unsuccessfulchemotherapy to improve treatment success, during which they should be monitored for intra-abdominalmetastasis and weight loss.     

Prognostic Impact of the Advanced Lung Cancer Inflammation Index (ALI) in Metastatic Non-Small Cell Lung Cancer Treated with First Line Chemotherapy

Background: The advanced lung cancer inflammation index (ALI) has been reported to predict the overall survival in patients with advanced non-small cell lung cancer (NSCLC). However, no previous studies have examined the prognostic significance of ALI in metastatic NSCLC treated with first line chemotherapy. The objective of this study was to explore the relationship between ALI and the prognosis of metastatic NSCLC treated with first line chemotherapy. Materials and Methods: Data of 109 metastatic NSCLC patients who had completed first line treatment with chemotherapy was collected. A multivariate flexible parametric proportional-hazards model with restricted cubic splines (RCS) was used to explore and identify the independent prognostic factors, including clinical potential factors and ALI for the overall survival. Multivariate regression analysis was used to evaluate the potential prognostic factors associated with short survival less than 6 months. The analysis of the restricted mean survival time (RMST) method was used to estimate the event-free time from zero to 18 months. Results: The median OS was 10.9 months (95%CI 9.57-13.18) and median PFS was 7.5 months (95%CI 6.85-8.00).The multivariate survival analyses revealed two prognostic factors for worse survival: Poor ECOG PS (HR46.90; 95%CI 2.90-758.73; p=0.007) and progressive disease after completing the first line chemotherapy treatment (HR 2.85; 95%CI1.18-6.88; p=0.02),whereas a low ALI     

Efficacy of First-line Chemotherapy Affects the Second-Line Setting Response in Patients with Advanced Non-Small Cell Lung Cancer

Background: Chemotherapy is the mainstay of treatment for the majority of patients with advanced nonsmall cell lung cancer (NSCLC) without driver mutations and many receive therapies beyond first-line. Secondline chemotherapy has been disappointing both in terms of response rate and survival and we know relatively little about the prognostic factors. Materials and Methods: One thousand and eight patients with advanced NSCLC who received second-line chemotherapy after progression were reviewed in Shanghai PulmonaryHospital, China, from September 2005 to July 2010. We analyzed the effects of potential prognostic factors on the outcomes of second-line chemotherapy (overall response rate, ORR; progression free survival, PFS; overall survival, OS). Results: The response and progression free survival of first-line chemotherapy affects the ORR, PFS and OS of second-line chemotherapy (ORR: CR/PR 15.4%, SD 10.1%, PD2.3%, p<0.001; PFS: CR/PR 3.80 months, SD 2.77 months, PD 2.03 months, p<0.001; OS: CR/PR 11.60 months, SD 10.33 months, PD 6.57 months, p=0.578, p<0.001, p<0.001, respectively). On multivariate analysis, better response to first-line therapy (CR/PR: HR=0.751, p=0.002; SD: HR=0.781, p=0.021) and progression within 3-6 months (HR=0.626, p<0.001), together with adenocarcinoma (HR=0.815, p=0.017), without liver metastasis (HR=0.541, p=0.001), never-smoker(HR=0.772, p=0.001), and ECOG PS 0-1 (HR=0.745, p=0.021) were predictors for good OS following secondline chemotherapy. Conclusions: Patients who responded to first-line chemotherapy had a better outcome after second-line therapy for advanced NSCLC, and the efficacy of first-line chemotherapy, period of progression, histology, liver metastasis, smoking status and ECOG PS were independent prognostic factors for OS.     

A contemporary prognostic nomogram for men with hormone-refractory metastatic prostate cancer: a TAX327 study analysis.

PURPOSE: To develop a prognostic model and nomogram using baseline clinical variables to predict death among men with metastatic hormone-refractory prostate cancer (HRPC). EXPERIMENTAL DESIGN: TAX327 was a clinical trial that randomized 1,006 men with metastatic HRPC to receive every three week or weekly docetaxel or mitoxantrone, each with prednisone. We developed a multivariate Cox model and nomogram to predict survival at 1, 2, and 5 years. RESULTS: Ten independent prognostic factors other than treatment group were identified in multivariate analysis: (a) presence of liver metastases [hazard ratio (HR), 1.66; P = 0.019], (b) number of metastatic sites (HR, 1.63 if > or =2 sites; P = 0.001), (c) clinically significant pain (HR, 1.48; P < 0.0001), (d) Karnofsky performance status (HR, 1.39 if < or =70; P = 0.016), (e) type of progression (HR, 1.37 for measurable disease progression and 1.29 for bone scan progression; P = 0.005 and 0.01, respectively), (f) pretreatment prostate-specific antigen (PSA) doubling time (HR, 1.19 if <55 days; P = 0.066), (g) PSA (HR, 1.17 per log rise; P < 0.0001), (h) tumor grade (HR, 1.18 for high grade; P = 0.069), (i) alkaline phosphatase (HR, 1.27 per log rise; P < 0.0001), and (j) hemoglobin (HR, 1.11 per unit decline; P = 0.004). A nomogram was developed based on this multivariate model and validated internally using bootstrap methods, with a concordance index of 0.69. CONCLUSIONS: This multivariate model identified several new independent prognostic factors in men with metastatic HRPC, including PSA doubling time, and led to the successful development of a clinically applicable nomogram. External prospective validation may support the wider use of this prognostic baseline model for men with HRPC treated with chemotherapy.     

基于SEER数据库分析胆囊癌肝转移患者预后因素并构建竞争风险列线图

目的:分析影响胆囊癌肝转移患者的预后因素,建立竞争风险列线图从而量化生存差异,提供临床决策。方法:本研究通过回顾性分析SEER数据库2010年至2015年共318例胆囊癌肝转移患者完整临床信息资料,采用单因素和多因素Cox回归分析得到影响患者总生存期的独立预后因素,采用Kaplan-Meier（Log-rank 检验）进行生存分析,并基于独立预后因素绘制竞争风险列线图。结果:318例胆囊癌肝转移患者,采用总生存期单因素和多因素Cox回归分析,结果显示病理分级(HR:1.397,95%CI:1.157~1.687,P<0.001)、手术方式(HR:0.790,95%CI:0.682~0.913,P=0.002)、化疗情况(HR:0.344,95%CI:0.265~0.446,P<0.001)和淋巴结检出数(HR:0.774,95%CI:0.642~0.933,P=0.007)是胆囊癌肝转移患者总生存期独立预后因素。通过将多因素Cox回归分析得到的显著临床病理参数建立列线图来评估影响总生存期的竞争性风险和量化生存差异。计算列线图C-index为7.46,并且0.5年、1年、3年的校正曲线显示列线图有着较好预测能力。结论:肿瘤病理分级、手术方式、淋巴结检出数和化疗情况是胆囊癌肝转移患者独立预后因素。基于列线图显示,化疗情况影响程度的权重值最大。     

162例局部晚期未手术老年肺鳞状细胞癌患者预后因素分析

目的 对局部晚期未手术老年肺鳞状细胞癌患者进行回顾性分析,确定影响预后的因素.方法 按纳入标准搜集2010年1月1日至2015年1月1日就诊于山西省肿瘤医院的未手术、局部晚期老年肺鳞状细胞癌患者162例.对相关预后因素分别进行Kaplan-Meier单因素和Cox回归多因素分析.结果 162例患者中位年龄73.6岁,总体中位生存期为19.4个月,1年生存率为71.0％,2年生存率为35.9％.Kaplan-Meier单因素分析示:年龄(x2=7.94,P=0.005)、美国东部肿瘤协作组(ECOG)评分(x2=42.12,P=0.000)、放化疗联合与否(x2=14.99,P=0.000)是影响生存的预后因素.Cox回归多因素分析示:ECOG评分(HR=0.30,95％ CI为0.19 ～0.46,P=0.000)、N分期(HR =0.65,95％CI为0.44 ～0.95,P =0.026)是影响预后的独立因素.结论 ECOG评分和N分期是影响未手术、局部晚期老年肺鳞状细胞癌患者生存期的独立预后因素.     

Ⅳ期非小细胞肺癌预后因素分析及胸部放疗的潜在意义

目的:分析Ⅳ期非小细胞肺癌（NSCLC）患者的疗效和预后因素,探讨胸部放疗在Ⅳ期NSCLC治疗中的意义。方法:回顾性分析79例有远处转移并行胸部放疗的Ⅳ期NSCLC患者的临床资料,采用Kaplan-Meier法计算其生存率,并采用Log-rank检验和单因素预后分析进行分析,对统计学有意义的因素进一步用Cox模型行多因素预后分析。结果:1、2年生存率分别为34.2%、12.3%,中位生存期为10个月。单因素分析结果显示影响Ⅳ期NSCLC预后的因素有是否吸烟、转移灶数、胸部放疗剂量（P=0.021、0.000 1、0.002）。多因素分析显示,转移灶数、胸部放疗剂量是系统化疗并行胸部三维适形放疗（3D-CRT）的Ⅳ期NSCLC的独立预后因素（P=0.002、0.045）。结论:Ⅳ期NSCLC行胸部放疗有潜在的临床意义,并且转移灶数目、胸部放疗剂量是影响其生存的显著预后因素。     

363例晚期老年非小细胞肺癌预后因素分析

目的回顾性分析>70岁的晚期非小细胞肺癌患者的临床资料和生存情况并进行统计学分析,探讨其预后相关因素。方法收集363例福建省肿瘤医院2006年1月至2010年12月收治>70岁的晚期非小细胞肺癌患者的临床资料和生存情况,采用Kaplan-Meier法计算生存率,Logrank检验进行单因素分析,多因素预后分析采用Cox回归模型。结果 363例患者的中位生存期为8.8个月,1年生存率为28.0%。ECOG评分、临床分期、肝转移、一线治疗疗效和靶向治疗是影响预后的独立因素(均P<0.005)。结论 ECOG评分>2分、Ⅳ期、有肝转移、一线治疗后进展和从未接受靶向治疗的晚期老年非小细胞肺癌患者预后较差。     

Pretreatment prognostic factors in patients with early-stage (I/II) non-small-cell lung cancer treated with hyperfractionated radiation therapy alone

PURPOSE: To investigate influence of various pretreatment prognostic factors in patients with early stage (I/II) non-small-cell lung cancer (NSCLC) treated with hyperfractionated radiation therapy alone. PATIENTS AND METHODS: One hundred and sixteen patients were treated with tumor doses of 69.6 Gy, 1.2-Gy, twice-daily fractionation. There were 49 patients with Stage I and 67 patients with Stage II. Eighty patients had Karnofsky performance status (KPS) 90-100 and 95 patients had <5% weight loss. Peripheral tumors were observed in 57 patients. Squamous histology was observed in 70 patients and the majority of patients had concomitant disease (n=72). RESULTS: The median survival time for all patients was 29 months; 5-year survival was 29%. The median time to local progression and the distant metastasis were not achieved, whereas 5-year local progression-free and distant metastasis-free survivals were 50% and 72%, respectively. Multivariate analysis identified KPS, weight loss, location, histology, and the reason for not undergoing surgery as prognostic factors for survival. KPS, location, and histology influenced local progression-free survival, whereas only KPS and weight loss influenced distant metastasis-free survival. CONCLUSIONS: This retrospective analysis identified KPS and weight loss as the most important prognostic factors of outcome in patients with early-stage NSCLC treated with hyperfractionation radiation therapy.     

A Nomogram for Predicting Progression-free Survival in Patients with Endometrial Cancer

AimsEndometrial cancer is one of the most widely known gynaecological malignancies that lacks a prognostic prediction model. This study aimed to develop a nomogram to predict progression-free survival (PFS) in patients with endometrial cancer.Materials and methodsInformation for endometrial cancer patients diagnosed and treated from 1 January 2005 to 30 June 2018 was collected. The Kaplan–Meier survival analysis and multivariate Cox regression analysis were carried out to determine the independent risk factors and a nomogram was constructed by R based on analytical factors. Internal and external validation were then carried out to predict the probability of 3- and 5-year PFS.ResultsIn total, 1020 patients with endometrial cancer were included in the study and the relationship between 25 factors and prognosis was analysed. Postmenopause (hazard ratio = 2.476, 95% confidence interval 1.023–5.994), lymph node metastasis (hazard ratio = 6.242, 95% confidence interval 2.815–13.843), lymphovascular space invasion (hazard ratio = 4.263, 95% confidence interval 1.802–10.087), histological type (hazard ratio = 2.713, 95% confidence interval 1.374–5.356), histological differentiation (hazard ratio = 2.601, 95% confidence interval 1.141–5.927) and parametrial involvement (hazard ratio = 3.596, 95% confidence interval 1.622–7.973) were found to be independent prognostic risk factors; these factors were selected to establish a nomogram. The consistency index for 3-year PFS were 0.88 (95% confidence interval 0.81–0.95) in the training cohort and 0.93 (95% confidence interval 0.87–0.99) in the verification set. The areas under the receiver operating characteristic curve for the 3- and 5-year PFS predictions are 0.891 and 0.842 in the training set; the same conclusion also appeared in the verification set [0.835 (3-year), 0.803(5-year)].ConclusionsThis study established a prognostic nomogram for endometrial cancer that provides a more individualised and accurate estimation of PFS for patients, which will help physicians make follow-up strategies and risk stratification.     

Long-term survival in patients with metastatic renal cell carcinoma treated with continuous intravenous infusion of recombinant interleukin-2: the experience of a single institution

AIM AND BACKGROUND: Metastatic renal cell carcinoma is one of the few tumors for which a clear benefit of immunotherapy has been demonstrated. The aim of this study was to evaluate the long-term survival of patients with metastatic renal cell carcinoma, along with response rate and other prognostic and predictive factors. PATIENTS AND METHODS: Between July 1989 and May 1995, 56 patients with metastatic renal cell carcinoma were treated in a single institution with high-dose recombinant interleukin-2 in continuous infusion. Survival was measured by the Kaplan and Meier method. Prognostic factors were assessed by univariate and multivariate analyses of survival (Cox proportional hazard ratio model). RESULTS: Of 56 patients, 15 had objective responses (26.8%), 16 stable disease (28.6%), 18 disease progressions (32.1%), and 7 (12.5%) were not valuable for response. Median overall survival was 20 months, and probability of 2- and 5-year survival was 41% and 21%, respectively. At multivariate analysis, the increased risk of death for: performance status > or = 2 vs 0 (HR = 6.20), stable disease (HR = 1.87), disease progression (HR = 10.61) vs partial or complete remission, and for hypotension and oliguria toxicity, G3 + G4 vs G1 + G2 (HR = 2.19). CONCLUSIONS: Our study confirms the activity of IL-2 based immunotherapy in renal cell carcinoma. Moreover, ECOG performance status, clinical response, hypotension and oliguria toxicity resulted as independent survival prognostic factors.     

Ⅳ期非小细胞肺癌预后影响因素分析

Objective: To investigate the prognostic factors for stage Ⅳ non-small cell lung cancer (NSCLC) with distant metastasis and establish a reliable model of clinical prognostic index.Methods: From January 1990 to April 2005,313 primary NSCLC patients with metastasis,who had been treated in Shanghai Chest Hospital,were reviewed.Survival time was estimated according to the Kaplan-Meier method.Cox proportional hazard regression model was used for multivariate analysis.Results: Among the 313 cases of non-small cell lung cancer (NSCLC) at stage Ⅳ,there were 218 and 95 patients with metastasis to single and different organs,respectively.The overall median survival time for all 313 cases of NSCLC patients was 10.8 (9.00,12.30)months and the overall 1-,2-,3-,4- and 5-year survival rate was 45%,18%,12%,4% and 0%.There were 63,174,127,36,18,11 and 5 patients with metastasis to brain (20.13%),bone (55.59%),lung (40.58%),liver (11.50%),adrenal gland (5.75%),subcutaneous (3.51%) and others,respectively.The survival time was shortest in subcutaneous metastasis (4.6 months),and liver 7.0 months,brain 8.0 months,adrenal gland 8.6 months,bone 10.6 months,lung 11.8 months.Kaplan-Meier estimation showed that patients anatomic typing,KPS,numbers of organ with metastasis,appetite,liver,adrenal gland and subcutaneous metastasis,body weight loss,smoking,index of smoking,chemotherapy,cycles of chemotherapy were the predictors of survival.Multivariate analysis showed survival statistically significant correlation with anatomic typing,KPS,appetite,liver and subcutaneous metastasis,body weight loss,cycles of chemotherapy.The relative risk (RR) was 1.51,1.97,1.55,1.67,2.56,and 2.56 respectively.Conclusion: Survival time decreases distinctly in patients who had distant metastasis to more than two different organs (P＜0.01).Bone is the commonest organ for distant metastasis in lung cancer.The prognosis is poor when lung cancer appears subcutaneous metastasis and liver metastasis.Independent prognostic factors in patient with stage Ⅳ non-small cell lung cancer were liver and subcutaneous metastasis,anatomic typing,KPS,appetite,body weight loss,cycles of chemotherapy.     

早发型非转移性结直肠癌患者预后预测模型的构建及外部验证

目的:探讨影响早发型非转移性结直肠癌（early-onset non-metastatic colorectal cancer,EONCRC）患者预后的相关独立危险因素,并构建列线图预测EONCRC患者预后。方法:从美国监测、流行病学和结果数据库SEER数据库中收集了9 097例EONCRC患者的数据,患者按照7∶3比例随机分配到训练集(6 369例)和验证集(2 728例)。通过单变量、多变量COX比例风险回归分析确定独立的预后因素,并构建列线图。 使用C指数、ROC曲线和校准曲线评价列线图的区分度、预测效能和校准度。使用新疆军区总医院收治的EONCRC患者临床资料(n=171)对列线图进行了外部验证并对其预后影响因素进行了分析。结果:多因素分析确定了与总生存期有关的8个独立风险因素,分别是组织学分化程度、组织学类型、神经浸润、分期、T分期、手术、化疗和放疗,并将它们纳入列线图。SEER训练集、SEER验证集、外部验证集的C指数值分别为0.765(95%置信区间,0.749~0.781)、0.785(95%置信区间,0.763~0.807)、0.766(95%置信区间,0.713~0.819),校准曲线表明了列线图预测总生存率与实际总生存率具有良好的一致性。ROC曲线显示,列线图可以准确预测EONCRC患者1年(AUC=0.834 9)、3年(AUC=0.794 7)和5年(AUC=0.771 2)的生存率。根据列线图的风险评分将患者分为高风险、中风险和低风险组,在SEER训练集、SEER验证集、外部验证集中,低风险组的5年生存率均最高,其次是中风险组和高危组。结论:本研究确定了EONCRC患者预后相关的8个独立危险因素,列线图能准确预测中国及美国EONCRC患者1年、3年、5年总生存率,对EONCRC患者进行个体化的分层及预后评估,为临床的诊疗提供科学依据。     

Failure of T stage to predict survival in patients with non-small-cell lung cancer treated by radiotherapy with or without concomitant chemotherapy

PURPOSE: Because T stage does not consistently reflect tumor size in non-small-cell lung cancer (NSCLC), we hypothesized that T stage may be of limited prognostic value in patients with locoregional NSCLC treated by nonsurgical means. METHODS AND MATERIALS: The study population consisted of 243 patients with histologically or cytologically proven NSCLC treated in three consecutive prospective trials between 1989 and 1998. The eligibility criteria for this analysis included planned for and began treatment at 60 Gy; Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1; weight loss < or = 10%; no prior treatment; and no supraclavicular nodes, pleural effusion, or distant metastases. In the first study, 204 patients were randomized to receive conventional or accelerated radiotherapy (RT) with or without concomitant carboplatin. In the second, 15 patients were treated with concomitant cisplatin, etoposide, and RT in a single-arm study. In the third, 24 patients were treated with concomitant carboplatin, 5-fluorouracil, and RT in a dose-escalation study. RESULTS: A total of 231 patients for whom the T and N stage were known met the eligibility criteria. The patient characteristics were 77% male, 64% squamous histologic features, 33% ECOG status of 0, and 69% no weight loss. The nodal status was 36% N0, 7% N1, 52% N2, and 5% N3. The estimated median survival for all patients was 1.4 years (95% confidence interval 1.2-1.6), with an estimated 10% surviving 5 years (95% confidence interval 7-15). No significant difference was found in survival among the three trials (p = 0.16). The estimated median survival time and 5-year survival rate according to T stage were as follows: T1 (n = 29), 1.6 years and 16%; T2 (n = 88), 1.3 years and 9%; T3 (n = 59), 1.4 years and 9%; and T4 (n = 55), 1.4 years and 9%. No significant trend was found in overall survival according to T stage (p = 0.85, log-rank). To test whether a significant effect of T stage on overall survival existed after adjusting for N stage, trial, ECOG status, and weight loss, a multifactor analysis using Cox proportional hazards regression analysis was carried out. There was still no significant effect of T stage on survival (p = 0.66) when all factors were taken into account. CONCLUSION: Although there is some evidence that T stage is an independent prognostic factor in patients with NSCLC treated surgically, it did not appear to be of value in this series of patients treated with RT with and without concomitant chemotherapy.     

老年广泛期小细胞肺癌患者的预后分析

目的:分析老年广泛期小细胞肺癌患者的独立预后因素。方法:回顾性研究2010年6月至2015年6月在安阳市肿瘤医院治疗的60例老年广泛期小细胞肺癌患者的临床资料，所有患者均经细胞学或组织病理明确诊断。采用Kaplan-Meier法计算生存时间和生存率，采用Log-rank检验单因素分析，对有统计学意义的单因素采用Cox风险模型进行多因素分析。结果:60例老年广泛期小细胞肺癌患者1年、2年、3年生存率分别为38.3%、8.3%、3.3%，中位生存时间为10.0个月。单因素分析显示年龄、ECOG评分、一线化疗疗效、化疗周期数、肝转移情况和合并慢性疾病情况是影响患者预后的因素，P值小于0.05，具有统计学差异。Cox风险模型分析显示，年龄、ECOG评分、一线化疗疗效、化疗周期数和肝转移情况对患者的总生存时间具有显著影响。结论:患者年龄、ECOG评分、一线化疗疗效、化疗周期数和肝转移情况是影响老年广泛期小细胞肺癌的独立预后因素。     

Prognostic factors in patients with stage IV non-small cell lung cancer

Lung cancer is the leading cause of cancer deaths among both men and women over the world. In 2002, lung can- cer accounted for more deaths than breast cancer, prostate cancer, and colon cancer combined[1]. Non-small cell lung cancer (NSCLC) represents 75%–85% of all lung cancers. Lung cancer is hard to discovered until it’s at an advanced stage and the outlook for recovery is poor. Approximately two-thirds of NSCLC patients have advanced-stage at di- agnosis. Stage IV NSCLC denotes …     

Prognostic model to predict outcomes in nonsmall cell lung cancer patients treated with gefitinib as a salvage treatment

BACKGROUND:

A prognostic model based on clinical parameters for nonsmall cell lung cancer (NSCLC) patients treated with gefitinib (250 mg/day) as a salvage therapy was devised.

METHODS:

Clinical data regarding a total of 316 metastatic or recurrent NSCLC patients who were treated with gefitinib were analyzed.

RESULTS:

Poor prognostic factors for overall survival (OS) by multivariate analysis were an Eastern Cooperative Oncology Group (ECOG) performance status of 2 to 3 (hazards ratio [HR] of 2.07; 95% confidence interval [CI], 1.57‐2.73 [P < .001]), the presence of intra‐abdominal metastasis (HR of 1.76; 95% CI, 1.33‐2.34 [P < .001]), elevated serum alkaline phosphatase (HR of 1.50; 95% CI, 1.13‐2.00 [P = .005]), time interval from diagnosis to gefitinib therapy of ≤12 months (HR of 1.48; 95% CI, 1.12‐1.95 [P = .005]), low serum albumin (HR of 1.45; 95% CI, 1.09‐1.92 [P = .009]), progression‐free interval for previous chemotherapy of ≤12 weeks (HR of 1.40; 95% CI, 1.0‐1.84 [P = .015]), white blood cell >10,000/μL (HR of 1.38; 95% CI, 1.02‐1.85 [P = .032]), and ever‐smoker (HR of 1.33; 95% CI, 1.02‐1.75 [P = .033]). Of the 272 patients applicable to this prognostic model, 41 patients (15%) were categorized as a good prognosis group (0‐1 risk factors), 100 patients (37%) as an intermediate prognosis group (2‐3 risk factors), 81 patients (30%) as a poor prognosis group (4‐5 risk factors), and 50 patients (16%) as a very poor prognosis group (≥6 risk factors). The median OS from the time of gefitinib treatment for the good, intermediate, poor, and very poor prognosis groups were 18.0 months, 11.2 months, 4.0 months, and 1.3 months, respectively (P < .001).

CONCLUSIONS:

This prognostic model based on easily available clinical variables would be useful to identify patients who might derive more benefit from gefitinib treatment and to make decisions in clinical practice. Cancer 2009. © 2009 American Cancer Society.     

非小细胞肺癌患者发生脑转移风险列线图预测模型的建立

目的:基于非小细胞肺癌(non-small cell lung cancer,NSCLC)患者发生脑转移风险的影响因素分析,建立列线图预测模型。方法:选取2011年06月至2015年06月在本院确诊为NSCLC的患者452例作为研究对象,收集患者的临床资料并进行随访,如果出现脑转移情况或5年随访时间已满,则随访终止,通过单因素和多因素的Cox回归分析得出发生脑转移风险的影响因素,在此基础上根据筛选出的变量建立列线图预测模型。结果:Cox回归最终筛选出的变量为TNM分期、分化程度、病理类型、CA125水平和淋巴结转移数目,建立的列线图预测模型C-index为0.801（95%CI:0.778~0.882）。结论:本研究建立的NSCLC患者发生脑转移风险的列线图预测模型,可以根据多因素分析结果中有意义的变量,较为准确的预测患者的预后情况,临床应用前景较好。     

Ⅰ期非小细胞肺癌预后因素的研究

目的 探讨Ⅰ期非小细胞肺癌(NSCLC)的联合预后因素。方法 回顾性分析58例Ⅰ期NSCLC患者的临床资料、术后病理结果和免疫组化技术检测的9项基因表达指标(c-myc、MDM2、c-erbB-2、EGFR、p53、p14^ARF、p16^INK4、p21^WAF1、nm23)。观察患者的总生存率、局部区域性复发率和远处转移率。结果 全组5年生存率、局部区域性复发率和远处转移率分别为71．1％,11．1％和33．5％。单因素分析结果表明,肿瘤细胞的低分化是影响总生存率的不良预后因素(P=0.028);c—myc与c-erbB-2的高表达均为影响总生存率和远处转移率的不良预后因素;促进肿瘤增殖基因总分组的高分值(P=0．041)与综合肿瘤基因组的高分值(P=0．006),是总生存率的不良预后因素。多因素分析结果表明,肿瘤细胞的分化程度与综合肿瘤基因的联合表达,是影响总生存率的独立预后因素。本组结果还显示,已行化疗的高危组患者,其总生存率与无远处转移率均优于未行化疗者,但差异尚未见有显著性。结论 肿瘤细胞的分化程度与综合肿瘤基因的表达,可能是Ⅰ期NSCLC的预后因素。高危组患者进行术后化疗似有提高疗效的趋势。