局限期小细胞肺癌综合治疗及预后影响因素分析

摘要

目的：探讨分析局限期小细胞肺癌（L - SCLC）的综合治疗疗效及影响预后的临床病理因素。方法回顾性分析96例于2003年1月至2010年12月行手术切除的 L - SCLC 患者的临床相关资料，分析手术为主，包括辅助放化疗在内的综合治疗疗效及预后的影响因素。结果 L - SCLC 总体5年生存率为32.0%。单因素分析结果显示性别、年龄、吸烟史、肿瘤部位等因素对患者生存率的影响均无明显统计学差异（ P ﹥0.05）。而手术切缘、手术方式、T 分期、N 分期、TNM 分期及 LDH 水平对患者生存率的影响有明显统计学差异（ P ﹤0.05）。关于综合治疗模式，发现新辅助化疗、术后辅助化疗及术后放疗均不是预后的影响因素，只有术后联合放化疗才能使患者的生存真正获益（ P ﹤0.05）。多因素分析，TNM 分期（ P ＝0.000）、术后联合放化疗（ P ＝0.022）以及 LDH 水平（ P ＝0.010）都是 L - SCLC 预后的独立影响因素。结论与非手术相比，L - SCLC 患者手术生存更优。TNM 分期、术后联合放化疗以及 LDH 水平都是影响L - SCLC 预后的独立因素，推荐对 L - SCLC 给予手术为主联合术后放化疗的综合治疗模式。%ObjectiveTo explore the treatment and prognostic factors of L - SCLC. Methods The clinical data of 96 inpatients admitted during January 2003 to December 2010 were retrospectively reviewed. The aim of this study was to evaluate the treatment and other factors affecting the overall survival. Results The overall 5 - year survival was 32. 0% . Gender,age,smoking history and tumor location were not prognostic fac-tors for L - SCLC( P ﹥ 0. 05),but bronchial stump,operation type,T stage,N stage,TNM stage and level of LDH were factors affecting the prognosis. According to the result of treatment,neoadjuvant chemotherapy,postoperative radiotherapy and chemotherapy were not prognostic fac-tors,but combined postoperative chemotherapy and radiotherapy was a prognostic factor( P ﹤ 0. 05). Cox regression suggested that TNM stage( P = 0. 000),combined postoperative chemotherapy and radiotherapy( P = 0. 022)and level of LDH( P = 0. 010)were independent factors af-fecting the prognosis. Conclusion The 5 - year survival rate of L - SCLC has significantly been increased through operation. TNM stage,com-bined postoperative chemotherapy and radiotherapy and the level of LDH were independent factors affecting the prognosis. Operation and combined postoperative chemotherapy and radiotherapy have been recommended for treatment of patients with L - SCLC.