射波刀治疗局部晚期非小细胞肺癌的生存及预后影响因素分析
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摘要
目的分析射波刀治疗局部晚期非小细胞肺癌的临床疗效及影响射波刀疗效的主要因素。方法选取2013年—2015年笔者所在中心收治的且接受射波刀治疗的局部晚期(Ⅲa、Ⅲb)非小细胞肺癌患者120例,回访统计其无病生存时间,及处方剂量、放疗次数、单次剂量、生物有效剂量、肿瘤大小、性别、年龄、肿瘤分期及病理分型等9个可能影响患者无病生存时间的因素,并使用SPSS 21软件绘制寿命表和生存曲线,建立Cox回归模型。结果局部晚期非小细胞肺癌经射波刀治疗后的中位生存期11.9个月,1年生存率为34%,2年生存率27%,3年生存率27%,1年生存比例为69%,2年生存比例为100%,3年生存比例为100%。Cox回归模型中4个变量"size"(肿瘤大小)、"gender"(性别)、"pathology"(病理类型)、"SD"(单次剂量)有显著意义(P<0.05)。结论接受射波刀治疗患者的中位生存期及1、2、3年生存率好于常规治疗者,肿瘤体积较大的患者死亡的危险性高;接受治疗的女性患者较男性生存率高;鳞癌较腺癌有更好的治疗效果;单次剂量越大,死亡风险越高。
Objective To analyse the clinical effects and the main influencing factors of local late stage non-small cell lung cancer treated with Cyberknife. Methods The 120 cases of local late stage(Ⅲa,Ⅲb) nonsmall cell lung cancer admitted in author's center and received treatment with Cyberknife from 2010 to 2012 yr.were enrolled in this study;authors analysed the disease-free survival time,prescribed dose,frequency,single dose,radiation biological effective dose,gender,age,tumor size,tumor staging and pathological typing,etc,nine factors which may affect Cyberknife treatment effect. Statistical software SPSS 16 was used to drawing Life tables,survival function and establishing Cox regression. Results The median survival time of local late stage non-small cell lung cancer treated with Cyberknife was for 11.9 months,1-year survival rate was 34%,2-year survival rate was27%,3-year survival rate was 27%,1-year proportion surviving was 69%,2-year proportion surviving was 100%,3-year proportion surviving was 100%;the four variables in Cox regression model: "size", "gender", "pathology", "SD" had significant significance(P<0.05). Conclusion The patients treated with Cyberknife have better median survival and 1-,2-,and 3-year survival rates than the patients treated with conventional radiotherapy. The higher risk of death in the patients with larger-size tumor is higher,as well male patients have higher survival rate than female,squamous carcinoma has a better therapeutic effect than adeno-carcinoma.
Objective To analyse the clinical effects and the main influencing factors of local late stage non-small cell lung cancer treated with Cyberknife. Methods The 120 cases of local late stage(Ⅲa,Ⅲb) nonsmall cell lung cancer admitted in author's center and received treatment with Cyberknife from 2010 to 2012 yr.were enrolled in this study;authors analysed the disease-free survival time,prescribed dose,frequency,single dose,radiation biological effective dose,gender,age,tumor size,tumor staging and pathological typing,etc,nine factors which may affect Cyberknife treatment effect. Statistical software SPSS 16 was used to drawing Life tables,survival function and establishing Cox regression. Results The median survival time of local late stage non-small cell lung cancer treated with Cyberknife was for 11.9 months,1-year survival rate was 34%,2-year survival rate was27%,3-year survival rate was 27%,1-year proportion surviving was 69%,2-year proportion surviving was 100%,3-year proportion surviving was 100%;the four variables in Cox regression model: "size", "gender", "pathology", "SD" had significant significance(P<0.05). Conclusion The patients treated with Cyberknife have better median survival and 1-,2-,and 3-year survival rates than the patients treated with conventional radiotherapy. The higher risk of death in the patients with larger-size tumor is higher,as well male patients have higher survival rate than female,squamous carcinoma has a better therapeutic effect than adeno-carcinoma.
引文
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[12]吴苏冬,康静波,朱奇,等.射波刀治疗非小细胞肺癌脑转移瘤的临床观察[J].中国医学装备,2017,14(11):77-80.
[13] GERSZTEN PC,BURTON SA,BELANI CR,et al. Radiosurgery for the treatment of spinal lung metastases[J]. Cancer,2006,107(11):2653-2661
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[15] YAO Y,WU GH,LU DQ,et al. Clinical study of accelerated hyperfractionated irradiation in the treatment of local adbanced non-small-cell lung cancer[J]. Acta Universitatis Medicinalis Secondae Shanghai,2003,23(1):59-71.
[2] JEMAL A,BRAY F,CENTER MM,et al. Global cancer statistics[J]. CA Cancer J Clin,2011,61(2):69-90
[3] CURRAN WJ,PAULUS R. Sequential vs concurrent chemoradiation for stage III Non-small Cell Lung Cancer:Randomized phase III trial RTOG 9410[J]. J Natl Cancer Inst,2011,103(1):1452-1460
[4] ALBAIN KS,SWANN RS,RUSCH VW,et al. Radiotherapy plus chemotherapy with or without surgical resection for stage III Non-small Cell Lung Cancer:a phase III randomised controlled trial[J]. Lancet,2009,374(1):379-386
[5]薛慧,钟青,刘虎,等.射波刀联合经导管肝动脉化疗栓塞治疗原发性肝癌的疗效及预后分析[J].传染病信息,2015,28(5):301-305.
[6] CHO YH,LEE JM,LEE D,et al. Experiences on two different stereotactic radiosurgery modalities of Gamma Knife and Cyberknife in treating brain:National Comprehensive Cancer Network[J]. Non-small Cell Lung Cancer Version,2015(7)[DB/OL].
[7] FERLAY J,SHIN HR. Estimates of worldwide burden of cancer in 2008[J]. Int J Cancer,2010,127(12):2893-2917.
[8]张涛,陈豫民,杨皓,等.非小细胞肺癌脑转移患者107例预后分析[J].肿瘤研究与临床,2015,27(3):168-170.
[9] MUEHLING B,WEHRMANN C,OBERHUBER A,et al. Comparison of clinical and surgical-pathological staging in III A non-small cell lung cancer patients[J]. Ann Surg Oncol,2012,19(1):89-93.
[10] QIU R,WANG YX,ZHU SC,et al. Effect on long-time survival for different tumor volume in stage III non-small cell lung cancer after three dimensional conformal radiotherapy[J].Cancer Research on Prevention and Treatment,2013,40(10):988-992.
[11]关高娃,康静波,张新红,等.射波刀治疗早期非小细胞肺癌的疗效与观察[J].转化医学杂志,2016,8(12):78-80.
[12]吴苏冬,康静波,朱奇,等.射波刀治疗非小细胞肺癌脑转移瘤的临床观察[J].中国医学装备,2017,14(11):77-80.
[13] GERSZTEN PC,BURTON SA,BELANI CR,et al. Radiosurgery for the treatment of spinal lung metastases[J]. Cancer,2006,107(11):2653-2661
[14] KONG FM,TEN HAKEN RK,SCHIPPER Mj,et al. Highdiose radiation improved local tumor control and overall survival in patients with inoperable/unresectable Non-small-cell lung cancer:longterm results of a radiation dose escalation study[J]. Int J Radiar Oncol Biol Phys,2005,63(2):324-333.
[15] YAO Y,WU GH,LU DQ,et al. Clinical study of accelerated hyperfractionated irradiation in the treatment of local adbanced non-small-cell lung cancer[J]. Acta Universitatis Medicinalis Secondae Shanghai,2003,23(1):59-71.