60岁以上晚期非小细胞肺癌患者生存预后的危险因素分析

摘要

Objective:To analyze the survival data and to investigate the prognostic factors of elderly patients aged 60 years and over with unresectable,advanced non-small cell lung cancer(NSCLC).Methods:The charts of 296 elderly (≥60 years) patients with unresectable,advanced NSCLC,diagnosed at the Pulmonary Department of Shanghai Chest Hospital affiliated to Shanghai Jiaotong University between Jan 2003 and Dec 2005 were retrospectively reviewed.Patients were divided into 4 groups based on age [(60～64 years old (n =66),65～69 years old (n =93),70～74 years old (n =89) and over 75 years old (n =48)].Patients' clinical characteristics,treatment and survival data were reviewed and analyzed to investigate the prognostic factors.Results:A total of 296 patients with advanced NSCLC were included.Male patients accounted for 73.0％.Adenocarcinoma accounted for 50.3％.Median overall survival (OS) was 13.20 months,the survival rate of 1-,2-,3-year were 53.0％,22.0％,4.0％ respectively.No significant difference in survival rate and median survival was found among 4 groups(P =0.32).Gender,smoking history,histological type,clinical stage and PS score had no significant difference in the distribution among 4 groups by univariate analysis,while the percentages of patients combing with chronic diseases and receiving chemotherapy had significant differences (P＜0.01).Partial correlation control analysis showed that there were significant correlations between chronic diseases and age (r1 =0.1916,P＜0.01),chemotherapy and age (r2 =-0.2550,P＜0.01),accepting effective treatment and chronic diseases (r3 =-0.2003,P＜0.01).Gender,histological type,clinical stage,PS score before chemotherapy affected the prognosis according to Cox multivariate analysis.Male,stage Ⅳ disease,PS score 2 and over were associated with a short survival time while adenocarcinoma derived significant survival benefit.Conclusions:Gender,stage of disease,perform ance status and histology are independent prognostic factors for elderly patients with advanced NSCLC.%目的:分析60岁以上未手术晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者的生存数据,探讨影响其预后的危险因素.方法:回顾分析上海交通大学附属胸科医院2003年1月-2005年12月收治的60岁以上未手术的晚期NSCLC患者296例,按年龄分4组,分别为60～64岁组(n=66)、65～69岁组(n=93),70～74岁组(n=89)及75岁以上组n=48,分析4组患者的临床特征及治疗情况对预后的影响.结果:296例患者中,73.0％为男性患者,50.3％病理类型为腺癌.中位生存期为13.2个月,患者1年、2年、3年的生存率分别为53.0％、22.0％、4.0％,4组患者的生存率及中位生存期总体上差异无统计学意义(P=0.32).单因素分析结果显示,患者性别、吸烟史、病理类型、临床分期及PS评分等因素在4组中的分布差异无统计学意义,而合并慢性疾病及是否化疗在4组中的分布差异有统计学意义(P＜0.01).偏相关控制分析表明,是否合并慢性疾病与年龄之间(r1=0.1916,P＜0.01)、是否化疗与年龄之间(,=-0.2550,P＜0.01)、是否接受化疗与是否合并慢性疾病之间存在显著的相关性(r3=-0.2003,P＜0.01).Cox多因素分析显示,患者的性别、病理类型、临床分期、化疗前PS评分是影响患者生存预后的危险因素,男性、病理分期为Ⅳ期、PS评分≥2分者的预后较差,而腺癌患者预后较好.结论:性别、临床分期、PS评分及组织学类型是影响60岁以上未手术晚期NSCLC患者生存预后的独立危险因素.