高龄(≥70岁)早期非小细胞肺癌胸腔镜术后生存的预后因素分析

摘要

目的 探讨影响高龄(≥70岁)Ⅰ期非小细胞肺癌( non-small cell lung cancer,NSCLC)患者术后生存的预后因素. 方法 回顾性分析2003年4月~2013年12月我院211例70岁及以上Ⅰ期NSCLC的临床及随访资料,对影响术后生存的预后因素采用Kaplan-Meier生存分析、log-rank检验及Cox回归分析. 结果 中位随访时间39个月( 0~93个月). 5年总生存率为66.9%,Kaplan-Meier生存分析和Cox单因素回归分析显示病变部位、病理分期、病变直径、分化程度、查尔森合并症指数(Chalson comorbidity index,CCI)对总生存期存在影响. Cox多因素回归分析显示:病变部位(HR=3.946, 95%CI 1.571~9.910)、病理分化(HR=2.003, 95%CI 1.049~3.824)、肿瘤直径(HR=2.841, 95%CI 1.478~5.462)及CCI (HR=3.920, 95%CI 1.767~8.698)是影响高龄早期肺癌患者术后生存的独立预后因素. 结论 对于早期高龄NSCLC患者, CCI、病变部位、分化程度、肿瘤直径是影响术后生存的重要预后因素. CCI对长期生存预后有一定的价值. 加强术前综合评估有利于指导预后.%Objective To investigate prognostic factors of long-term survival in elderly patients with stage Ⅰ non-small cell lung cancer ( NSCLC) . Methods We conducted a retrospective review of clinical and follow-up data of 211 patients aged ≥70 years old with stageⅠNSCLC April 2003 to December 2013 in our department.The Kaplan-Meier survival analysis, log-rank test,and Cox regression analysis were carried out to investigate the prognostic factors. Results The median follow-up time was 39 months (range, 0 -93 months).The 5-year overall survival rate was 66.9%.The Kaplan-Meier survival analysis and Cox univariate regression analysis indicated that tumor location,pathological stage, tumor size, pathological differentiation, Chalson comorbidity index ( CCI) were correlated to overall survival.The Cox multivariate analysis demonstrated that tumor location ( HR =3.946, 95%CI 1.571-9.910), pathological differentiation (HR=2.003, 95%CI 1.049-3.824), tumor size (HR=2.841, 95%CI 1.478 -5.462), and CCI (HR=3.920, 95%CI 1.767-8.698) were independent prognostic factors of postoperative long-term outcomes in elderly patients with early stage NSCLC. Conclusions For elderly patients with stage Ⅰ NSCLC, the CCI, tumor location, pathological differentiation, and tumor size predicts a long-term survival.The CCI is of important value for predicting a long-term survival.Comprehensive preoperative assessment may benefit the prognostic estimation.