老年Ⅲ期非小细胞肺癌放化疗的影响因素分析

摘要

Objective To evaluate the clinical outcome of radical radiotherapy (RT ) with or without chemo-therapy for elderly patients with stage Ⅲ non-small cell lung cancer (NSCLC) .Methods From 1990 to 2010 ,125 patients ,aged 70 years or more ,received radical RT with or without chemotherapy for treatment of stage ⅢNSCLC .We reviewed the patients prognostic factors ,including comorbidities .Comorbidity status was evaluated using a simplified comorbidity score (SCS) .Of the patients reviewed ,82 received radical RT alone ,whereas the other 43 patients underwent chemoradiotherapy (CRT ) .A platinum-based chemotherapy regimen was most com-monly used in 42 cases .Results The two-year overall-survival (OS) and progression-free survival (PFS) rates were 32 .2% and 21 .8% ,respectively .SCS was the independent prognostic factor for OS .In the frail elderly sub-group with a SCS of ≥10 ,CRT demonstrated a significant difference in PFS ,but not in OS .In contrast ,OS and PFS following CRT were significantly superior to RT in the fit elderly subgroup with a SCS of <10 .The incidence of severe pulmonary toxicities in the frail elderly subgroup was significantly higher than that in the fit elderly sub-group .Conclusion Multiple comorbidities evaluated according to the SCS are related to poor OS in elderly patients with stage Ⅲ NSCLC .CRT improved clinical outcome when compared to RT in the fit elderly subgroup .Howev-er ,the gain from this treatment was negated in the frail elderly subgroup with multiple comorbidities .Therefore , evaluation of comorbidity is necessary in order to determine whether chemotherapy should be combined with RT in elderly patients with stage Ⅲ NSCLC.%目的：探讨影响老年非小细胞肺癌预后的影响因素，评估简易共病评分在判断老年非小细胞肺癌预后的作用。方法选择河北省沧州市中西医结合医院1990-2010年125例接受放化疗的老年非小细胞肺癌患者，年龄均＞70岁，并且临床分期为Ⅲ期，其中，82例接受了单纯放疗，42例接受了放疗和以铂类为基础的静脉化疗，1例接受了口服吉非替尼的靶向治疗。回顾性分析上述病例的各种影响因素，包括共存病。寻找影响老年非小细胞肺癌预后的影响因素。结果本组病例2年总生存率和无病进展生存率为32.2％和21.8％。简易共病评分为老年非小细胞肺癌患者预后的独立影响因素。亚组分析显示：在体质状况较差患者中，评分低的患者无病进展生存率明显高于评分高者，而总生存率无差别。本研究数据显示，评分高的患者较评分低的患者更容易出现急性肺损伤。结论多因素分析显示简易共病评分为老年非小细胞肺癌患者预后的独立影响因素。对于评分高的患者放疗联合化疗能提高生存率，而对于评分低者单纯放疗是更好的选择。