1826例非小细胞肺癌的预后因素分析

目的 探讨影响非小细胞肺癌(NSCLC)预后的相关因素,分析分期和脉管瘤栓对非小细胞肺癌预后的影响.方法 回顾1826例NSCLC患者的临床资料,将可能影响NSCLC预后的风险因子进行单因素和多因素分析,确定NSCLC预后的影响因素.应用Kaplan-Meier法分析分期和脉管瘤栓对患者生存率的影响.结果 单因素分析显示,影响NSCLC预后的因素为肿瘤家族史(P=0.02)、组织学类型(P=0.005)、分期(P=0.002)和脉管瘤栓(P=0.002).经Cox回归分析,分期为Ⅲ期和有脉管瘤栓是影响NSCLC预后的独立危险因素.Ⅰ、Ⅱ、Ⅲ期患者的5年生存率分别为57.4%、34.2%和18.7%(P=0.001),同一分期中,有无脉管瘤栓患者的生存率差异有统计学意义(P＜0.05),有脉管瘤栓或无脉管瘤栓者在各分期之间的生存率差异亦有统计学意义(P＜0.05),有脉管瘤栓患者复发或转移的发生率(69.9%)显著高于无脉管瘤栓者(36.7%,P＜0.001).结论 分期和脉管瘤栓是影响NSCLC预后的重要因素,并且脉管瘤栓还可作为判断NSCLC侵袭和转移的重要因子.

Analysis of prognostic factors in 1826 patients with completely resected non-small cell lung cancer

OBJECTIVE: To analyze the factors affecting the prognosis of completely resected nonsmall cell lung cancer (NSCLC), and to assess the impact of vascular invasion and TNM stage on prognosis. METHODS: Between March 1, 1997 and March 1, 2002, a total of 1826 pathologically confirmed NSCLC patients with complete resection were enrolled in this study. The major clinical and pathological features were analyzed, and the impact of vascular invasion on prognosis was investigated. Statistical analysis was performed with SPSS software. Fisher's exact test was used to assess the correlation of vascular invasion with the other clinicopathological variables. Survival was analyzed by Kaplan-Meier method and Cox regression. RESULTS: Of the 1826 patients, 126 were found to have vascular invasion. Univariate analysis revealed that the following factors was significantly correlated with shorter overall survival: family history of cancer, histological type, pathological stage and vascular invasion, whereas multivariate analysis confirmed that only pathological stage and vascular invasion were the significant prognostic factors with a hazard ratio of 2.80 95% CI 1.74 - 4.86] and 4.76 95% CI 2.38 - 6.21], respectively. The overall 5-year survival rate of this series was 57.4% for stage I, 34.2% for stage II and 18.7% for stage III (P = 0.001) ,respectively. It was 59.1% for stage I 36.2% for stage II and 20.0% for stage III for those without vascular invasion, whereas for those with vascular invasion, it was 37.5% for stage I, 24.0% for stage II and 7.0% for stage III, respectively. There was a significant difference among the patients with different TNM stage and between the patients with vascular invasion and without (P < 0.05) by log-rank test. The distant metastasis rate of the patients with vascular invasion was 69.9% versus 36.7% in those without (P < 0.001). CONCLUSION: Our results show that TNM stage and vascular invasion are significant prognostic factors in nonsmall cell lung cancer. Vascular invasion can not only serve as an independent prognostic factor, but can also predict the possibility of metastasis.