肺不张与晚期非小细胞肺癌预后的相关性研究及其机制的初步探讨

目的探讨肺不张与Ⅲ、Ⅳ期不能手术切除的晚期非小细胞肺癌预后的关系。方法回顾性分析122例晚期非小细胞肺癌患者,合并肺不张纳入At(+)组,其余纳入At(-)组。采用Kaplan-Meier法进行生存分析,Log-rank检验比较生存期的差异,多因素Cox比例风险模型进行预后影响因素分析,并记录所有患者初次就诊时的相关实验性检查指标,利用t检验及曼-惠特尼U检验统计两组的差异,研究肺不张与相关实验性检查指标的关系。结果 38.5%的患者初次就诊时合并肺不张。At(+)组的中位数生存时间明显优于At(-)组17个月(95%CI15.146～18.854)vs.14个月(95%CI12.252～15.748),P=0.01],Ⅲ期患者尤为显著19个月(95%CI10.946～27.054)vs.16个月(95%CI13.981～18.019),P=0.008],而Ⅳ期患者无显著差异12个月(95%CI10.760～13.240)vs.11个月(95%CI9.042～12.958),P=0.398]。Ⅲ期合并肺不张的患者血小板计数及神经元特异性烯醇化酶(NSE)水平明显低于无肺不张的患者(P=0.0013,P=0.0397)。多变量Cox回归分析显示肺不张、体力状态(PS)评分、TNM分期是影响晚期非小细胞肺癌预后的独立因素(P=0.041,P=0.005,P=0.000)。结论肺不张是晚期非小细胞肺癌预后的有利因素,肺不张与血小板计数及NSE水平相关。

The relationship between atelectasis and prognosis of advanced non-small cell lung cancer

Objective To investigate the relationship between atelectasis(At)and prognosis of unresectable stage Ⅲ and Ⅳ non-small cell lung cancer(NSCLC).Methods Clinical records of 122 patients with advanced NSCLC were retrospectively evaluated.Patients were divided into At(+)Group with the presence of At and At(-)Group with the absence of At.Survival analysis was evaluated through Kaplan-Meier and Log-rank tests,and multivariate analysis was preformed using Cox proportional hazards regression model.Laboratory parameters that might be related with prolonged survival in At were compared using Student′s t test or Mann-Whitney test.Results 38.5% of the patients manifested At at the time of their first evaluation.Survival was significantly better in patients with At than without At17 months(95% CI 15.146-18.854)vs.14 months(95% CI 12.252-15.748),P=0.01].Survival was significantly longer in stage Ⅲ patients with At19 months(95% CI 10.946-27.054)vs.16 months(95% CI 13.981-18.019),P=0.008],but not in stage Ⅳ patients12 months(95% CI 10.760-13.240)vs. 11 months(95% CI 9.042-12.958),P=0.398].Patients with At in stage Ⅲ had significantly lower platelet counts and neuron specific enolase(NSE)than did those with no At(P=0.0013,P=0.0397).Multivariate analysis showed that At,ECOG performance status and TNM stage were independent predictors for survival(P=0.041,P=0.005,P=0.000).Conclusions At is a favorable prognostic factor in advanced NSCLC.There is also a clear association between At and platelets and NSE.