局部放疗联合化疗在广泛期小细胞肺癌患者中的作用

摘要

背景与目的化疗作为广泛期小细胞肺癌（extensive-stage small cell lung cancer, ES-SCLC）的主要治疗方法，其有效率高，但容易发生快速耐药。局部治疗作为姑息治疗方法，能够缓解局部症状和提高患者生活质量，但是能否延长生存期尚缺乏证据。本研究旨在分析在全身化疗基础上的局部放疗对ES-SCLC患者生存的作用与影响。方法回顾性分析302例ES-SCLC患者临床资料，采用Kaplan-Meier法及Cox多因素回归分析预后因素。结果全组患者中位无进展生存期（progression-free survival, PFS）4.4个月，中位生存期（median survival time, MST）10.4个月，1年生存率37.8%；2年生存率10.2%；3年生存率4.4%。原发灶放疗＋化疗组和单纯化疗组患者MST分别为14.3个月和8.2个月（P<0.01）；多处转移灶局部治疗、一处转移灶局部治疗和未行转移灶局部治疗患者MST分别为18.7个月、12.3个月和8.9个月（P<0.01）；主动性的转移灶局部治疗、被动性的转移灶局部治疗和未行转移灶局部治疗患者MST分别为16.0个月、10.9个月和9.4个月（P<0.01）；全脑预防性照射治疗（prophylactic cranial irradiation, PCI）和未行PCI患者MST分别为19.8个月和9.9个月（P<0.01）。原发灶放疗、转移灶局部治疗和PCI是ES-SCLC患者的独立预后因素（P<0.01）。结论原发灶放疗、转移灶局部治疗和PCI能够延长ES-SCLC患者生存期。%Background and objective Chemotherapy is a highly effcient primary treatment for extensive-stage small cell lung cancer (ES-SCLC). However, patients receiving such treatment are prone to develop drug resistance. Local treatment is palliative and thus can alleviate the local symptoms and improve quality of life, but limited evidence is available for prolonging survival. Hence, this study evaluated the role of local treatment in chemotherapy of patients with ES-SCLC. Methods A total of 302 ES-SCLC cases were enrolled in this retrospective study. Prognostic factors were analyzed by Kaplan-Meier and Cox multivariate proportional hazards model. Results Median progression-free survival (PFS) and median survival time (MST) of the patients were 4.4 and 10.4 months, respectively. 1-, 2-, and 3-year survival rates were 37.8%, 10.2%and 4.4%, correspondingly. hTe MST of the primary tumor radiotherapy plus chemotherapy group was 14.3 months, whereas that of the chemotherapy group was 8.2 months (P<0.01). hTe MSTs of multiple-site, single-site, and non-metastasis local treatments were 18.7, 12.3 and 8.9 months, respectively (P<0.01). hTe MSTs of initiative, passive, and non-metastasis local treatments were 16.0, 10.9 and 9.4 months, correspondingly (P<0.01). hTe MSTs of patients with prophylactic cranial irradiation (PCI) and those without PCI were 19.8 and 9.9 months, respectively (P<0.01). Primary tumor radiotherapy, metastasis local treat-ment, and PCI were independent prognostic factors for ES-SCLC. Conclusion Primary tumor radiotherapy, metastasis local treatment, and PCI can signiifcantly improve survival in patients with ES-SCLC.