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目的肿瘤的局部复发和远处转移是非小细胞肺癌(non-small cell lung cancer,NSCLC)治疗失败和死亡的最主要原因。本研究评价与NSCLC患者复发/转移后生存时间(postrecurrence survival,PRS)和总生存率(overall survival,OS)相关的临床病理因素。方法回顾性分析2005-01-01-2011-12-31于中日友好医院胸外科行肺叶切除+纵隔淋巴结清除的160例NSCLC患者临床资料及随访资料,病理分期为pⅠA~ⅢA期且经过随访均发生局部复发或者远处转移,应用SPSS 20.0对资料进行统计分析。应用Kaplan-Meier曲线及Cox回归对根治性切除术后OS和PRS相关风险因素进行分析。结果 160例患者平均年龄62岁,其中鳞癌41例,腺癌101例,其他类型NSCLC 18例(腺鳞癌11例,大细胞癌7例)。随访终点43例发生局部复发,93例发生远处转移,24例同时发生局部复发和远处转。入组患者中位生存时间45个月;复发/转移后中位生存时间20个月。单因素分析结果显示,性别、TNM分期和复发/转移与OS有相关性,P<0.05;年龄、吸烟指数、吸烟史、病理类型、淋巴血管浸润、复发/转移时间≤12个月、复发转移时间≤24个月、术后有无(放)化疗以及复发后有无治疗亦与OS具有相关性,P<0.01。多因素分析结果显示,年龄(HR=0.23,95%CI:0.14~0.38,P<0.01)、吸烟指数(HR=11.28,95%CI:2.53~50.26,P<0.01)、TNM分期(HR=1.50,95%CI:1.08~2.07,P<0.05)、复发时间≤24个月(HR=0.31,95%CI:0.16~0.60,P<0.01)、术后有无放化疗(HR=0.82,95%CI:0.68~0.99,P<0.05)、复发后有无治疗(HR=1.40,95%CI:1.24~1.58,P<0.01)为影响OS的独立危险因素。单因素分析结果显示,年龄、吸烟指数、病理类型、TNM分期、术后有无(放)化疗和复发后有无治疗与PRS有相关性,P<0.01;复发/转移亦与PRS有相关性,P<0.05。多因素分析结果显示,年龄(HR=0.26,95%CI:0.18~0.45,P<0.01)、吸烟指数(HR=1.73,95%CI:1.12~2.68,P<0.05)、术后有无(放)化疗(HR=0.77,95%CI:0.66~0.91,P<0.01)、复发后有无治疗(HR=1.36,95%CI:1.22~1.52,P<0.01)为影响PRS的独立危险因素。结论NSCLC患者OS和PRS与多个因素密切相关,其中术后早期(≤24个月)发生复发/转移的患者预后较差;复发/转移后治疗可以显著改善患者的OS与PRS。
Local recurrence and distant metastasis of the target tumor are the major causes of failure and death of non-small cell lung cancer (NSCLC). This study evaluated the clinicopathologic factors associated with postrecurrence survival (PRS) and overall survival (OS) in NSCLC patients. Methods The clinical data and follow-up data of 160 patients with NSCLC who underwent pneumonectomy and mediastinal lymph node dissection at the Department of Thoracic Surgery, Sino-Japanese Friendship Hospital from January 2005 to December 31, 2011 were retrospectively analyzed. The patients were followed up for a period of pⅠA to ⅢA All cases had local recurrence or distant metastasis. SPSS 20.0 was used to analyze the data. Kaplan-Meier curves and Cox regression were used to analyze the risk factors of OS and PRS after radical resection. Results The average age of the 160 patients was 62 years old, including 41 cases of squamous cell carcinoma, 101 cases of adenocarcinoma and 18 cases of other types of NSCLC (11 cases of adenosquamous carcinoma and 7 cases of large cell carcinoma). At the end of follow-up, 43 cases had local recurrence, 93 cases had distant metastasis, and 24 cases had local recurrence and distant metastasis at the same time. The median survival time was 45 months in the enrolled patients and 20 months after the recurrence / metastasis. Univariate analysis showed that sex, TNM stage and recurrence / metastasis were related to OS, P <0.05; age, smoking index, smoking history, pathological type, lymphatic invasion, recurrence / metastasis ≤12 months, recurrence and metastasis Time ≤24 months, whether postoperative chemotherapy (radiotherapy) and relapse after treatment with OS also has relevance, P <0.01. Multivariate analysis showed that smoking (HR = 11.28, 95% CI: 2.53-50.26, P <0.01), age (HR = 0.23,95% CI: 0.14-0.38, P <0.01) (HR = 0.31, 95% CI: 0.16-0.60, P <0.01), with or without radiotherapy and chemotherapy after operation (HR = 0.82, P 0. 05) 95% CI: 0.68-0.99, P <0.05). There was no significant difference between the two groups (HR = 1.40, 95% CI: 1.24-1.58, P <0.01). The results of univariate analysis showed that age, smoking index, pathological type, TNM stage, postoperative chemotherapy and postoperative recurrence and PRS were correlated (P <0.01), and relapse / metastasis was correlated with PRS , P <0.05. The results of multivariate analysis showed that the smoking index (HR = 1.73, 95% CI: 1.12-2.68, P <0.05), age (HR = 0.26,95% CI: 0.18-0.45, P < (HR = 0.77, 95% CI: 0.66-0.91, P <0.01), and the presence or absence of treatment after recurrence (HR = 1.36,95% CI: 1.22-1.52, P <0.01) was an independent risk factor for PRS . Conclusion OS and PRS are closely related to multiple factors in patients with NSCLC. Among them, the prognosis of patients with recurrence / metastasis in the early postoperative period (≤24 months) is poor. The treatment of recurrence / metastasis can significantly improve the patients’ OS and PRS.