Retrospective Study on 158 Limited-Stage Small-Cell Lung-Cancer Patients after Combined Therapy
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摘要:
目的 探讨局限期小细胞肺癌接受综合治疗后的疗效及其预后因素。 方法 回顾性分析2006年1月至2008年6月于河北医科大学第四医院综合治疗的158例局限期小细胞肺癌临床资料，所有病例均经病理证实，接受化疗者146例（92.4%），化疗方案多为EP、EC、TP、CAP，平均化疗5个周期（1~17个）；接受放疗者120例（75.9%），平均等效剂量54Gy（20~79.25 Gy）；接受手术者49例（31.0%），其中楔形切除2例、段切除3例、叶切除25例、全肺切除19例。综合治疗模式包括：放疗±化疗109例（69.0%）、手术±化疗38例（24.1%）、手术+放疗+化疗11例（6.9%）。采用Kaplan-Meier法计算生存率，采用Log-rank法进行单因素分析，多因素分析采用Cox比例风险模型筛选影响预后因素，P < 0.05为差异具有统计学意义。 结果 全组总有效率（CR+PR）86.7%，中位生存期24个月，1、3、5年生存率分别为76.3%、39.1%、36.4%。单因素分析显示临床分期、近期疗效、化疗、放疗、放疗等效剂量、手术对预后产生明显影响（P < 0.05）；多因素分析显示近期疗效、化疗、放疗等效剂量是影响患者预后的独立因素。 结论 局限期SCLC综合治疗方案的优选还有待进一步研究。而采取多学科的综合治疗，有望进一步提高局限期SCLC的预后。 Abstract:Objective To evaluate the condition of limited-stage small-cell lung-cancer (LD-SCLC) patients after combined therapy. Methods The medical data of 158 LD-SCLC patients treated with combined therapy between January 2006 and June 2008 were retrospectively analyzed. A total of 146 patients received chemotherapy, 120 received radiotherapy, and 49 underwent surgery. The combined therapies included radiotherapy ± chemotherapy, surgery ± chemotherapy, and surgery + radiotherapy + chemotherapy. The Kaplan-Meier estimation was used for the survival analysis. Results The overall response rate (CR + PR) was 86.7%. The median survival time was 24 months, and the 1-, 3-, and 5-year survival rates were 76.3%, 39.1%, and 36.4%, respectively. The short-term clinical effect and the chemotherapy and radiotherapy doses were the influential factors for prognosis. Conclusion Combined therapy can achieve good results for LD-SCLC patients. Further study is needed to choose the best combined therapy model. -
Key words:
- Small-cell lung cancer /
- Combination therapy /
- Chemotherapy /
- Radiotherapy /
- Surgery /
- Survival rate
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图 1 各组生存率比较
Figure 1. Comparison of overall survival rate among groups of different treatments
表 1 各组临床分期比较 例（%）
Table 1. Comparison of clinical stage among different groups
表 2 临床分期分层后各组生存率比较
Table 2. Comparison of survival rate in each group after stratification by clinical stage
表 3 158例局限期小细胞肺癌患者预后的单因素分析
Table 3. Univariate analysis of prognosis of 158 limited-stage small cell lung cancer patients
表 4 放疗与无放疗组间、手术与无手术组间临床分期的比较 例（%）
Table 4. Comparison of clinical stage between radiotherapy and non-radiotherapy and surgery and non surgery groups
表 5 临床分期分层后放疗、手术对预后的影响
Table 5. Effect of radiotherapy and surgery on survival after stratificatoin by clinical stage
表 6 158例局限期小细胞肺癌患者预后的多因素分析
Table 6. Multivariate analysis of prognosis of 158 limited-stage small cell lung cancer cases
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