【摘要】：研究背景小細胞肺癌(small cell lung cancer,SCLC)占所有肺癌類型的15%～20%,是一類易于侵犯血管并早期肺門及縱隔淋巴結(jié)甚至遠處轉(zhuǎn)移的肺癌,進展較快,預后較差。這些特征與小細胞肺癌組織病理學類型相關。依托泊苷聯(lián)合鉑類制劑的化療方案是目前SCLC化療的一線治療方案�；瘜W治療聯(lián)合放射治療為目前SCLC的治療選擇方案。SCLC患者個體間差異較大,治療預后差異顯著,獲益懸殊。分析依托泊苷聯(lián)合鉑類制劑一線化療的療效及其他臨床預后因素將有助于小細胞肺癌個體化治療的發(fā)展。材料和方法收集2011年01月至2016年06月于山東大學附屬省立醫(yī)院呼吸內(nèi)科就診,通過組織活檢,組織病理學結(jié)果可確診為SCLC的患者。按照嚴格的納入標準、排除標準來選擇病例,最終納入221例患者。通過病案查詢,收集患者接受2次化療后的病情評估、疾病無進展生存期及不良反應,以及性別、年齡、吸煙史、戒煙史、ECOG評分、腫瘤標志物NSE、病理免疫組化Ki-67、血鈉濃度、治療方案、是否聯(lián)合放療、化療周期等臨床信息。通過SPSS 22.0軟件及GraphPad軟件進行數(shù)據(jù)處理,卡方檢驗各因素與療效的相關性,Log-rank法進行顯著性檢驗。采用Kaplan-Meier法繪制患者的無進展生存期生存曲線以及單因素分析,有意義者納入COX比例風險模型進行多因素分析,取p0.05有統(tǒng)計學意義。結(jié)果1、221例患者中,男女比例為2.2:1,年齡范圍為26～82歲,局限期SCLC為108例,廣泛期SCLC為113例。所有患者均接受了依托泊苷+鉑類制劑化療方案治療,其中單純化療者為120例,放化療結(jié)合者101例。187例化療初次反應評估達CR/PR,34例為SD/PD。2、疾病分期、PS評分、Ki-67與患者依托泊苷聯(lián)合鉑類制劑化療首次化療療效評估相關,局限期、PS評分低分組、Ki-67(-)～(++)組中患者首次化療療效評估有效率高,分別是91.7%、89%、96.8%。其中局限期(OR0.337 95%CI 0.127-0.896 P=0.029)、PS 評分(OR 1.956,95%CI 1.004-3.808,p=0.049)為其獨立預后因素。Ki-67需要結(jié)合其他指標綜合判斷其首次化療療效評估及預后。3、從無進展生存期來看,PS評分低(p=0.0122)、血鈉正常組(p=0.0065)、化療周期≥4個周期(p0.0001)、放化療聯(lián)合組(p0.0001)、首次化療療效評估CR+PR(p0.0001)的無進展生存期顯著較長。但COx回歸分析中,結(jié)果示性別、年齡、PS評分、治療模式、化療周期、血鈉、化療療效首次評估等均不是小細胞肺癌的獨立預后因素。結(jié)論1、局限期、PS評分0～1分、Ki-67(-)～(++)組中患者首次化療療效評估有效率高,其中局限期、PS評分0-1是首次化療療效評估的獨立預后因素,Ki-67需要結(jié)合其他指標綜合判斷。2、PS評分0～1分、無低鈉血癥、放化療聯(lián)合治療、化療周期≥4個周期、首次化療療效評估CR/PR者無進展生存期顯著較長。
[Abstract]:Background small cell lung cancer (small cell lung cancer) is a kind of lung cancer which is prone to invasion of blood vessels and metastasis of early hilar and mediastinal lymph nodes. These characteristics are related to the histopathological types of small cell lung cancer. Etoposide combined with platinum is the first-line chemotherapy regimen for SCLC. Chemotherapy combined with radiotherapy is the current treatment option for SCLC patients. To analyze the therapeutic effect of etoposide combined with platinum preparation and other clinical prognostic factors will contribute to the development of individual therapy for small cell lung cancer. Materials and methods patients with SCLC were collected from January 2011 to June 2016 in the Department of Respiratory Medicine affiliated to Shandong University. Select cases according to strict inclusion criteria, exclusion criteria, and eventually 221 patients. According to the inquiry of medical records, we collected the evaluation of patients' condition after two times of chemotherapy, the disease survival time and adverse reaction, sex, age, smoking history, history of smoking cessation, score of ECOG, tumor marker NSE, pathological immunohistochemical Ki-67, serum sodium concentration. Treatment plan, whether the combination of radiotherapy, chemotherapy cycle and other clinical information. The data were processed by SPSS 22.0 software and GraphPad software. The correlation between factors and curative effect was tested by Chi-square method and Log-rank method. The Kaplan-Meier method was used to draw the survival curve and single factor analysis. The significant subjects were included in the COX proportional risk model for multivariate analysis. Results in 1221 cases, the ratio of male to female was 2.2: 1, the age range was 2682.108 cases of partial SCLC and 113 cases of extensive SCLC. All the patients were treated with etoposide platinum preparation chemotherapy regimen, 120 of them were treated with chemotherapy alone. The initial response of 101 patients with chemotherapy combined with radiotherapy and chemotherapy was assessed to be 34 cases of CRP / PRN as SD-PD.2.The score of Ki-67 was correlated with the evaluation of the first chemotherapy effect of etoposide combined with platinum preparation. In the group of Ki-67 (-) ~ (-), the effective rate of the first chemotherapy was 91.7% and 96.8%, respectively. OR0.337 95%CI 0.127-0.896 P0. 029) PS score (OR 1. 95695) is the independent prognostic factor. Ki-67 needs to be combined with other indicators to evaluate the efficacy and prognosis of the first chemotherapy. The PS score is low (p0. 0122), the blood natrium is normal (p0. 0065), and chemotherapy is necessary. The progression-free survival time was significantly longer in the combination of radiotherapy and chemotherapy group (p0.0001) than in the first chemotherapy group (p0.0001). The first time chemotherapy was used to evaluate the efficacy of CR PR (p0.0001. However, the results of COx regression analysis showed that sex, age and PS score, treatment mode, chemotherapy cycle, blood sodium and the first evaluation of chemotherapy efficacy were not independent prognostic factors of small cell lung cancer. Conclusion 1. The effective rate of the first chemotherapy in the group of limited PS score 0 ~ 1 and Ki-67 (-) ~ (-) was higher than that in the control group. PS score 0-1 was an independent prognostic factor in the evaluation of the efficacy of the first chemotherapy. Ki-67 should be combined with other indexes to judge the score of 0 ~ 1, no hyponatremia, combined radiotherapy and chemotherapy, and chemotherapy cycle 鈮，

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