早期非小细胞肺癌放疗预后影响因素分析

 目的　分析早期非小细胞肺癌（NSCLC）放射治疗的疗效及预后影响因素。方法　收集不能或不愿手术的早期NSCLC患者81例。其中鳞状细胞癌60例，腺癌16例，腺鳞癌及未分型癌5例。常规放疗45例，三维适形放疗36例；剂量为50～96 Gy。Kaplan-Meier法和Log-rank法比较生存率，Cox回归分析法进行多因素分析。结果　全组中位生存时间34个月，总1、3、5年生存率分别为88.7 %、41.9 %、21.8 %。单因素分析显示：不同Karnofsky评分（χ2＝19.56，P＝0.000）、临床分期（χ2＝8.83，P＝0.003）、肿瘤直径（χ2＝8.13，P＝0.004）、近期疗效（χ2＝14.87，P＝0.000）对生存影响差异有统计学意义。多因素回归分析显示放射治疗前Karnofsky评分（χ2＝11.27，P＝0.001）和肿瘤直径（χ2＝4.89，P＝0.027）是影响早期NSCLC患者预后的独立因素。结论　放射治疗前Karnofsky评分、肿瘤直径对早期NSCLC患者放射治疗的预后可能产生明显影响。

Analysis of prognostic influencing factors for early non-small-cell lung cancer after radiotherapy

Objective To evaluate the prognosis influencing factors of early non-small cell luny cancer （NSCLC） after radiotherapy. Methods 81 early NSCLC patients received definitive radiotherapy and were eligible. Among these patients, 60 were diagnosed as squamous cell carcinoma, 16 were adenocarcinoma and 5 were diagnosed through imaging instead of pathology. 45 patients received conventional radiotherapy, 36 patients received three dimensional conformal radiotherapy （3D-CRT）, All of them received a total dose of 50- 96 Gy with a median dose of 67.8 Gy. Kaplan-Meier survival curves and Cox regression model analysis were applied to evaluate the survival and prognostic factors. Results The median survival time was 34 months.The 1-, 3- and 5-year survival rates （OS） were 88.7 %, 41.9 %, 21.8 %, respectively. Karnofsky performance status≥80 ,Clinical stage, diameter≤4 cm and the therapeutic effect were associated with improving overall survival. Cox hazards model showed that Karnofsky performance status≥ 80 and diameter≤ 4 cm were likely to be independent positive prognostic factors. Conclusion Karnofsky performance status and tumor diamater can be used to evaluate the prognosis of early NSCLC after radiotherapy.