转移性Ⅳ期非小细胞肺癌患者的生存状况及预后分析
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摘要
目的探讨转移性Ⅳ期非小细胞肺癌患者生存状况、影响预后的相关因素以及寡转移与多发转移患者间的生存差异。方法回顾性分析90例转移性Ⅳ期非小细胞肺癌患者的临床资料,利用Kaplan-Meier法进行生存分析,并进行Log-rank检验,利用比例风险模型(Cox模型)进行多因素分析,筛选出相关因素。结果 90例转移性非小细胞肺癌患者1、2、3和5年总生存率分别为64.4%、21.1%、8.8%和1.1%,中位生存时间为14.5个月。寡转移和多发转移患者的1、2和3年生存率分别为89.4%、34.0%、17.0%和37.2%、6.9%、0%,中位生存时间分别为18个月和8个月,两者总生存率比较,差异具有统计学意义(χ2=27.104,P<0.01)。单因素分析结果显示,患者生存情况在KPS评分、组织学类型、转移状况、化疗周期数(≥4个或<4个)、原发病灶控制情况、靶向治疗及治疗模式方面比较,差异均具有统计学意义(均P<0.05)。多因素分析显示,KPS评分、原发灶已控、靶向治疗、寡转移和靶向治疗参与的治疗模式是预后的独立因素(均P<0.05)。结论 KPS≥70分、原发灶已控和寡转移的转移性非小细胞肺癌患者的生存期较长,是潜在的治疗获益患者。
Objective To study the survival and prognostic factors of patients with metastatic stage Ⅳ non-smallcell lung cancer( NSCLC) and the survival difference between oligometastatic and multiple metastatic patients. Methods The clinical data of 90 patients with metastatic stage Ⅳ NSCLC were retrospectively reviewed. Survival analysis was performed with Kaplan-Meier method and Log-rank test. Cox's proportion risk model was applied to complete multivariate analysis to identify related prognostic factors. Results Of 90 patients,the 1-year,2-year,3-year and 5-year overall survival rates were 64. 4%,21. 1%,8. 8% and 1. 1%,respectively,and the median survival time was 14. 5 months. Besides,the 1-year,2-year and 3-year overall survival rates were 89. 4%,34. 0% and 17. 0% in the oligometastatic patients,and 37. 2%,6. 9% and 0% in multiple metastatic patients,respectively. The median survival time was 18 months in the oligometastatic patients,and was 8 months in the multiple metastatic patients( χ2= 27. 104,P < 0. 01). Univariate analysis showed that the survival was significantly diffferent in terms of KPS score,histological types,metastasis,chemotherapy cycles( ≥4 vs < 4),primary tumor control,target therapy and therapy modes( all P < 0. 05). Multivariate analysis indicated that KPS score,primary tumor control,target therapy,oligometastasis and therapy modes were independent prognostic factors( all P <0. 05). Conclusion Metastatic NSCLC patients with KPS score ≥70,controlled primary tumor and oligometastatic status tend to have longer survival time and may be benefited more from treatments.
Objective To study the survival and prognostic factors of patients with metastatic stage Ⅳ non-smallcell lung cancer( NSCLC) and the survival difference between oligometastatic and multiple metastatic patients. Methods The clinical data of 90 patients with metastatic stage Ⅳ NSCLC were retrospectively reviewed. Survival analysis was performed with Kaplan-Meier method and Log-rank test. Cox's proportion risk model was applied to complete multivariate analysis to identify related prognostic factors. Results Of 90 patients,the 1-year,2-year,3-year and 5-year overall survival rates were 64. 4%,21. 1%,8. 8% and 1. 1%,respectively,and the median survival time was 14. 5 months. Besides,the 1-year,2-year and 3-year overall survival rates were 89. 4%,34. 0% and 17. 0% in the oligometastatic patients,and 37. 2%,6. 9% and 0% in multiple metastatic patients,respectively. The median survival time was 18 months in the oligometastatic patients,and was 8 months in the multiple metastatic patients( χ2= 27. 104,P < 0. 01). Univariate analysis showed that the survival was significantly diffferent in terms of KPS score,histological types,metastasis,chemotherapy cycles( ≥4 vs < 4),primary tumor control,target therapy and therapy modes( all P < 0. 05). Multivariate analysis indicated that KPS score,primary tumor control,target therapy,oligometastasis and therapy modes were independent prognostic factors( all P <0. 05). Conclusion Metastatic NSCLC patients with KPS score ≥70,controlled primary tumor and oligometastatic status tend to have longer survival time and may be benefited more from treatments.
引文
[1]Torre LA,Bray F,Siegel RL,et al.Global cancer statistics,2012[J].CA Cancer J Clin,2015,65(2):87-108.
[2]Chen W,Zheng R,Zeng H,et al.The incidence and mortality of majorcancers in China,2012[J].Chin J Cancer,2016,35(1):73.
[3]林动,许凌,林景辉,等.埃克替尼一线治疗EGFR敏感性突变的晚期非小细胞肺癌的疗效观察[J].实用肿瘤杂志,2015,30(3):220-224.
[4]张波,卢冰,苏胜发,等.Ⅳ期肺小细胞肺癌化疗同期胸部三维放疗前瞻性临床研究(四)-近期疗效对生存的影响[J].中华放射肿瘤学杂志,2012,21(1):29-34.
[5]Tartari RF,Ulbrich-Kulczynski JM,Filho AF,et al.Measurement of mid-arm muscle circumference and prognosis in stageⅣnon-small cell lung cancer patients[J].Oncol Lett,2013,5(3):1063-1067.
[6]林耀彬,龙浩.非小细胞肺癌寡转移研究进展[J].临床外科杂志,2016,24(7):509-513.
[7]Sacher AG,Le LW,Lau A,et al.Real-world chemotherapy treatment patterns in metastaticnon-small cell lung cancer:are patients undertreated?[J].Cancer,2015,121(15):2562-2569.
[8]Abernethy AP,Arunachalam A,Burke T,et al.Real-world first-line treatment and overallsurvival in non-small cell lung cancer withoutknown EGFR mutations or ALKrearrangements in US community oncologysetting[J].PLo S One,2017,12(6):e0178420.
[9]毕良文,张丽珍,时前军,等.老年非小细胞肺癌的生存状况及预后分析[J].中国实用医药,2014,9(28):20-22.
[10]杨开来,李简.Ⅳ期非小细胞肺癌预后因素分析[J].医学研究杂志,2016,45(1):74-78.
[11]Enders F,Geisenberger C,Jungk C,et al.Prognostic factors and long-term survival in surgically treated brain metastases from non-small cell lung cancer[J].Clin Neurol Neurosurg,2016,142:72-80.
[12]丛蕾,崔言刚,王潍博,等.晚期非小细胞肺癌化疗预后因素的COX回归分析[J].中国癌症杂志,2009,19(4):280-283.
[13]Hoang T,Xu RH,Schiller HS,et al.Clinical model to predict survival in chemonaive patients with advanced non-small cell lung cancer treated with third-generation chemotherapy regimens based on Eastern Cooperative Oncology Group data[J].J Clin Oncol,2005,23(1):175-183.
[14]张矛,孙涛,崔洪霞,等.原发灶及转移灶放疗在Ⅳ期寡转移非小细胞肺癌中的疗效分析[J].中华临床医师杂志(电子版),2017,11(4):543-549.
[15]Onesti CE,Iacono D,Angelini S,et al.Unexpected long survival of brain oligometastatic non-small cell lung cancer(NSCLC)treated with multimodal treatment:a single-center experience and review of the literature[J].Transl Lung Cancer Res,2016,5(6):712-719.
[16]Masters GA,Temin S,Azzoli CG,et al.Systemic therapy for stageⅣnon-small-cell lung cancer:American Society of Clinical Oncology clinical practice guideline update[J].J Clinic Oncol,2015,33(30):3488-3515.
[17]任艳萍,吕斌,郑向鹏.立体定向放疗治疗早期非小细胞肺癌的现状与问题[J].实用肿瘤杂志,2017,32(5):401-405.
[18]龙金华,卢冰,欧阳伟炜,等.Ⅳ期非小细胞肺癌化疗同期胸部三维放疗的前瞻性临床研究(三)——不同放疗剂量对生存的影响[J].中华放射肿瘤学杂志,2012,21(1):23-27.
[2]Chen W,Zheng R,Zeng H,et al.The incidence and mortality of majorcancers in China,2012[J].Chin J Cancer,2016,35(1):73.
[3]林动,许凌,林景辉,等.埃克替尼一线治疗EGFR敏感性突变的晚期非小细胞肺癌的疗效观察[J].实用肿瘤杂志,2015,30(3):220-224.
[4]张波,卢冰,苏胜发,等.Ⅳ期肺小细胞肺癌化疗同期胸部三维放疗前瞻性临床研究(四)-近期疗效对生存的影响[J].中华放射肿瘤学杂志,2012,21(1):29-34.
[5]Tartari RF,Ulbrich-Kulczynski JM,Filho AF,et al.Measurement of mid-arm muscle circumference and prognosis in stageⅣnon-small cell lung cancer patients[J].Oncol Lett,2013,5(3):1063-1067.
[6]林耀彬,龙浩.非小细胞肺癌寡转移研究进展[J].临床外科杂志,2016,24(7):509-513.
[7]Sacher AG,Le LW,Lau A,et al.Real-world chemotherapy treatment patterns in metastaticnon-small cell lung cancer:are patients undertreated?[J].Cancer,2015,121(15):2562-2569.
[8]Abernethy AP,Arunachalam A,Burke T,et al.Real-world first-line treatment and overallsurvival in non-small cell lung cancer withoutknown EGFR mutations or ALKrearrangements in US community oncologysetting[J].PLo S One,2017,12(6):e0178420.
[9]毕良文,张丽珍,时前军,等.老年非小细胞肺癌的生存状况及预后分析[J].中国实用医药,2014,9(28):20-22.
[10]杨开来,李简.Ⅳ期非小细胞肺癌预后因素分析[J].医学研究杂志,2016,45(1):74-78.
[11]Enders F,Geisenberger C,Jungk C,et al.Prognostic factors and long-term survival in surgically treated brain metastases from non-small cell lung cancer[J].Clin Neurol Neurosurg,2016,142:72-80.
[12]丛蕾,崔言刚,王潍博,等.晚期非小细胞肺癌化疗预后因素的COX回归分析[J].中国癌症杂志,2009,19(4):280-283.
[13]Hoang T,Xu RH,Schiller HS,et al.Clinical model to predict survival in chemonaive patients with advanced non-small cell lung cancer treated with third-generation chemotherapy regimens based on Eastern Cooperative Oncology Group data[J].J Clin Oncol,2005,23(1):175-183.
[14]张矛,孙涛,崔洪霞,等.原发灶及转移灶放疗在Ⅳ期寡转移非小细胞肺癌中的疗效分析[J].中华临床医师杂志(电子版),2017,11(4):543-549.
[15]Onesti CE,Iacono D,Angelini S,et al.Unexpected long survival of brain oligometastatic non-small cell lung cancer(NSCLC)treated with multimodal treatment:a single-center experience and review of the literature[J].Transl Lung Cancer Res,2016,5(6):712-719.
[16]Masters GA,Temin S,Azzoli CG,et al.Systemic therapy for stageⅣnon-small-cell lung cancer:American Society of Clinical Oncology clinical practice guideline update[J].J Clinic Oncol,2015,33(30):3488-3515.
[17]任艳萍,吕斌,郑向鹏.立体定向放疗治疗早期非小细胞肺癌的现状与问题[J].实用肿瘤杂志,2017,32(5):401-405.
[18]龙金华,卢冰,欧阳伟炜,等.Ⅳ期非小细胞肺癌化疗同期胸部三维放疗的前瞻性临床研究(三)——不同放疗剂量对生存的影响[J].中华放射肿瘤学杂志,2012,21(1):23-27.